If you are a provider with a new ACO and you already have approved authorizations in place with your former Health Plan, no resubmission is needed.
You can submit outpatient and inpatient authorization requests, confirm authorization numbers and check the status of an authorization on the WellSense provider portal. Register for access today!
See if a prior authorization is required
Before scheduling a service or procedure, determine whether or not it requires prior authorization.
- Search prior authorization requirements by using one of our lookup tools:
- If approval is required, review the medical and payment policies.
- Reference your patient’s covered services list to understand what’s covered by their plan
- Submit the prior authorization request:
- For Medical Prior Authorizations, submit electronically to WellSense through our online portal
- For pharmacy prior authorizations, click here
For prior authorizations for the below services, please use the following contact information:
- Radiology/Cardiology: 888-693-3211, Prompt #4; 844-725-4448, Prompt #1; Fax: 888-693-3210
- Genetic Testing (Lab Management): 844-725-4448, Prompt #2; Fax: 844-545-9213
- MSK-Spine, Joint, Pain: 844-725-4448, Prompt #3 Physical Medicine; Fax: 855-774-1319
- For additional eviCore resources: click here.
*If you require training or assistance with our online portal, please contact your dedicated provider Relations Consultant. The online portal is the preferred method for submitting Medical Prior Authorization requests. The Medical Prior Authorization Form can also be downloaded from the Documents & Forms Section, if necessary.
If your prior authorization is denied, you or the member may request a member appeal. The Plan may be required to get written permission from the member for you to appeal on their behalf. For more information on the member appeal process, please reference the prior authorization denial letter or Section 10 of the Provider Manual: Appeals, Inquiries and Grievances.
Documents & forms
- Access prior authorization documents and forms. (submitting via the Provider Portal is the preferred method)
- Access training guides for the provider portal.