Policies - Massachusetts
The policies below summarize WellSense Health Plan's medical coverage criteria and claims payment guidelines for specific services. You will also find policies related to administrative services.
The policies are used as a guide by the Plan to make clinical determinations regarding health care coverage and reimbursement. The Plan's policies undergo regular updates; check back often for the most up-to-date information. Providers are reminded that member eligibility is determined before medical coverage policies and reimbursement guidelines are applied to any claim. As a result, the Plan cannot guarantee payment when a member is ineligible or a non-covered benefit is rendered.
- Durable Medical Equipment Policies
- Qualified Health Plans (Commercial)
- MassHealth (Medicaid)
- Senior Care Options - Contact Northwood directly
- Radiology Policies
- Fraud, Waste and Abuse Policy
- Administrative Appeals Policy
- Involuntary Member Transfer or Plan Disenrollment Policy
Search the policies categories below (3)
View provider resources
You are leaving the WellSense website
You are now leaving the WellSense website, and are being connected to a third party web site. Please note that WellSense is not responsible for the information, content or product(s) found on third party web sites.
By accessing the noted link you will be leaving our website and entering a website hosted by another party. Please be advised that you will no longer be subject to, or under the protection of, our privacy and security policies. We encourage you to read and evaluate the privacy and security policies of the site you are entering, which may be different than ours.