Massachusetts provider resources

Tools and resources for working with WellSense Health Plan 

Appeals Backlog

Due to a backlog of provider appeal requests, appeals are currently taking longer than 30 days to process. 

We expect to return to a 30-day minimum processing time for submitted appeals beginning June 1, 2023. Thank you for your patience.

Application Backlog

The Provider Enrollment Department is experiencing an application backlog. We ask that you only contact us if your application is over 90 days old.

If you have an urgent request, please reach out to your Provider Relations Consultant or log into the provider portal for faster claims and authorization updates.

Pharmacy Vendor Transition

Learn about our recent pharmacy vendor transition.


Learn More

Senior Care Options Training
Take the required Senior Care Options (SCO) Model of Care training. The training is provided annually to newly-participating providers.

Get Started

ACO resources

In 2023, WellSense expanded its MassHealth coverage through eight ACO partnerships across Massachusetts.

ACO resources for providers

MassHealth redetermination
Find resources for Medicaid members whose coverage is no longer protected by the COVID-19 federal public health emergency.

Redetermination materials

Documents & forms

Important news and notices, claims and appeals resources, prior authorization and pharmacy forms and more.

Find a document or form

Pharmacy resources

Find updated formularies, check drug coverage, and locate pharmacies.

Find medical coverage criteria and claims payment guidelines for specific services. 
Prior authorization

Prior authorization resources for certain procedures, services and drugs.

Additional resources

Select a topic to learn more

Key Dates

Mar 1 - June 30 MassHealth Plan Selection Period
Nov 1 - Jan 23 Health Connector Open Enrollment
Dec 23 Health Connector Payment for January Plans
Jan 23 Health Connector Payment for February Plans