Prior Authorization

Determine if a Service Requires Prior Authorization

Before scheduling a behavioral health service, medical service or procedure, first confirm if the service is covered by Well Sense Health Plan, New Hampshire Medicaid, or one of our partners. 

  1. Search prior authorization requirements using: Not all services and procedures that require prior authorization may be listed. If you don’t see a service or procedure above, contact us.
  2. If the service is for behavioral health (BH), durable medical equipment (DME), or outpatient radiology, after reviewing the prior authorization matrix, please contact our partners (listed in the matrix) with any prior authorization questions.
  3. If the service requires authorization, review the medical policies to see if there is a new policy for the service or procedure. You may also call our Provider Service Line.
  4. To understand what your patient’s plan covers, reference the Covered Service List for Well Sense Health Plan. 
  5. Submit a prior authorization request by fax or online. 

Next Step: Submit prior authorization request

You spoke, we listened!

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Based on your feedback – we have removed prior authorization requirements on over 500 outpatient service codes effective with dates of service starting May 29, 2014. 

Confirm if a service still requires a prior authorization using our look up tools.

Check Service

Submit Prior Authorizations Online

Submit and track your prior authorization requests by logging in to our portal.

Don't have a login? Register here.

Non-Participating Providers

If you are a non-participating provider and have received prior approval to provide service to a member, you must complete paperwork to become active in our system prior to providing a service.

Complete paperwork here.