Upcoming changes to prior authorization procedure:
Beginning March 1, all providers will be required to submit outpatient and inpatient authorization requests*, confirm authorization numbers and check the status of an authorization using the WellSense provider portal.
Determine if prior authorization is required
Use the tools below to determine if prior authorization is required for certain procedures, services or drugs.
Submit a prior authorization request
If prior authorization is required, submit a prior authorization request using the instructions below.
Log in to our provider portal to submit your prior authorization request online.
Alternatively, you may fax a prior authorization form. This method will result in longer processing times.
*For New Hampshire providers, the primary method for submitting authorization requests will be the WellSense provider portal. For those providers who continue to submit prior authorization requests via fax, these requests are expected to experience longer processing times.
|Prior authorization for medications
|Durable medical equipment
(joint surgeries, spine surgeries, and interventional pain management treatments)
Appealing a prior authorization decision
If your prior authorization is denied, you or the member may request a member appeal. Use the Appeal Representative Authorization Form 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.