Provider manual
Download the WellSense Provider Manual for detailed information on the Plan, including our Clarity, Medicaid and Medicare Advantage programs.
- 2025 Provider Manual
- Section 1: General Information
- Section 2: Member Eligibility
- Section 3: Credentialing
- Section 4: Provider Responsibilities
- Section 5: Provider Resources
- Section 6: Member Information
- Section 7: Member Benefit Information
- Section 8: Utilization Management and Prior Authorization
- Section 9: Billing and Reimbursement
- Section 10: Member Appeals, Inquiries, and Grievances
- Section 11: Care Management Services
- Section 12: Behavioral Health Management
- Section 13: Pharmacy Services
- Section 14: Quality Management
- 2026 Provider Manual
- Section 1: General Information
- Section 2: Member Eligibility
- Section 3: Credentialing
- Section 4: Provider Responsibilities
- Section 5: Provider Resources
- Section 6: Member Information
- Section 7: Member Benefit Information
- Section 8: Utilization Management and Prior Authorization
- Section 9: Billing and Reimbursement
- Section 10: Member Appeals, Inquiries, and Grievances
- Section 11: Care Management Services
- Section 12: Behavioral Health Management
- Section 13: Pharmacy Services
- Section 14: Quality Management
- Provider Manual
- Section 1: General Information
- Section 2: Member Eligibility
- Section 3: Credentialing
- Section 4: Provider Responsibilities
- Section 5: Provider Resources
- Section 6: Member Information
- Section 7: Member Benefit Information
- Section 8: Utilization Management and Prior Authorization
- Section 9: Billing and Reimbursement
- Section 10: Member Appeals, Inquiries, and Grievances
- Section 11: Care Management Services
- Section 12: Behavioral Health Management
- Section 13: Pharmacy Services
- Section 14: Quality Management
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