Prior Authorization
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!
Determine if prior authorization is required
Use the tools below to determine if prior authorization is required for certain procedures, services or drugs.
For procedures or services
- HCPCS lookup: Massachusetts | New Hampshire
- CPT lookup: Massachusetts | New Hampshire
- Prior authorization matrix: Massachusetts | New Hampshire
Submit a prior authorization request
If prior authorization is required, submit a prior authorization request using the instructions below.
| Type | Instructions |
|---|---|
|
Medical |
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. |
| Pharmacy | Prior authorization for medications |
| Behavioral health | |
| Durable medical equipment |
Check this document to confirm which provider types are managed by Northwood, Inc and which are managed by WellSense. |
| Outpatient radiology |
|
| Vision services | |
| Dental services |
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.
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