Prior Authorizations

See if a Prior Authorization is Required

Before scheduling a service or procedure, determine whether or not it requires prior authorization.

  1. Search prior authorization requirements by using one of our lookup tools:
  2. If approval is required, review the medical and payment policies.
  3. Reference your patient’s covered services list to understand what’s covered by their plan
  4. Submit the prior authorization request:
    • For Medical Prior Authorizations, submit electronically to WellSense through our online portal
    • For pharmacy prior authorizations, 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.

Appeals

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