Training and support

Your dedicated Provider Relations Consultant is available to help you and your associates (ancillary providers, clinicians, vendors, administrative staffs, hospital staffs, and health center staffs) navigate our system and understand our policies and procedures. Your dedicated Provider Relations Consultant will:

  • Serve as your main point of contact with WellSense and respond promptly to your questions and concerns
  • Provide ongoing education and support
  • Create reports at your request
  • Help you determine which services are covered and/or require prior authorization
  • Work with you to correct claims
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Quick reference guides

Use these handy guides to quickly access WellSense contact, partner, claims, appeals and prior authorization information.

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Provider orientation materials

Need more help? Reach out to your Provider Relations Consultant, call our dedicated provider line at 888-566-0008, or email us.

Training resources

  • Provider registration process
    Learn how to register for a Well Sense Health Plan HealthTrio account.
  • Portal overview and basic functionality
    Gain an understanding of the portal's basic functionality, including checking member eligibility and claim status.
  • Submitting claims
    Learn the steps for submitting a claim, how to view the status of a claim, and search for a remittance advice.
  • Request for claim review, appeals, corrected claims or credit balance
    How to use the Request for Claim Review Form for all EDI claim corrections and claim re-adjudication requests.
  • Eligibility
    Learn how to check member eligibility in our provider portal.
  • Office management
    Learn how to revalidate account users and add, remove or modify users.
  • Prior authorizations (updated 6/23/23)
    Learn how to submit prior authorization requests and check the status of your requests.
  • Manage member information
    Learn how to update various member data online.
 


Enhancing your communication skills helps you to provide quality care to all your patients regardless of race, ethnicity, or religious beliefs. The resources below can help you assess and improve your cultural competency.

  • Foundations of disability – competent care (DCC) model -  this training focuses on delivering respectful, high-quality care to individuals with disabilities. It covers the common healthcare challenges faced by people with disabilities and explains how the DCC model's seven pillars help overcome these barriers.
  • Cultural responsiveness - this training will help you develop the skills and knowledge needed to engage with individuals from various backgrounds, ensuring that every interaction is thoughtful and culturally aware.
  • Provision of language services - this training explains how to make sure your communications and services are accessible to all patients, especially those with Limited English Proficiency (LEP). It covers how to identify the language and other needs of patients and how to regularly review your materials to keep them accessible.
    The goal is to ensure that all patients and potential patients can easily communicate with you and understand your information, no matter their language or communication preferences.
  • Cultural competency training - A free, online educational program accredited for physicians, physician assistants, and nurse practitioners. A training program is also available for nurses and social workers.
  • New National CLAS standards - An implementation guide from the Office of Minority Health to help you advance health equity and quality for all cultures within your practice or healthcare organization.
  • Guide: 12 Steps to Cultural Competency

Visit lep.gov/translation for materials that can be printed and kept on hand for patients who need translation assistance during office visits.

  • Behavioral health providers should call Carelon Behavioral Health at 866-444-5155 for any questions or issues that they may have.
  • Durable medical equipment, prosthetic, orthotic and medical supply (DMEPOS) providers should contact Northwood, Inc. at 866-802-6471 for any questions or issues that they may have.
  • Radiology providers (not including those associated with observation or ER visits) should contact eviCore at 866-802-6471 with questions or concerns.