Notice: Federal No Surprises Act Qualified Services/Items
If you are not a WellSense network provider and will be administering a one-time service to a WellSense member, you must do the following to receive payment:
- Complete the Non-Participating Provider Activation Form
- Fax the completed form, along with a copy of your W-9 form, to 617-897-0818, to the attention of the Provider Enrollment Department
You must receive prior authorization before delivering services to a WellSense member. Complete the Universal Massachusetts Prior Authorization Form, or call 800-900-1451, Option 3.
If you do not obtain prior authorization, your claim may be denied, unless the claim is for emergency care.
Senior Care Options
If you're delivering a service to a WellSense Senior Care Options member, you must also submit a Waiver of Liability.
Documents & Forms
Access administrative forms and documents.