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.

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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.

Search the policies categories below (3)


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