WellSense Health Plan fax number

Fax destination details

Department

Behavioral Health / Utilization Management (Provider Relations)

Purpose

Prior authorization for behavioral health services (e.g., Applied Behavioral Analysis) and behavioral health admission/notification forms; provider PA submissions.

Form

Prior Authorization Form — Applied Behavioral Analysis Prior Authorization Form (MassHealth) – WellSense MA plans

Address

WellSense Health Plan, 100 City Square, Suite 200, Charlestown, MA 02129

Voice phone

888-566-0010

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

For initial requests, services may be requested for a 3-month timeframe; for continued services, a 6-month timeframe; the Board-Certified Behavior Analyst (BCBA) must complete the form and include supporting documentation (e.g., IEP or diagnostic evaluation).

Official form instructions are published as a downloadable file on the organization's website.