Prior Authorization is a mechanism for the Executive Office of Health and Human Services (EOHHS) to review, 
assess, and approve, modify, or deny requests for certain elective non-emergency medical services prior to 
payment.  Prior Authorization serves as a cost containment and utilization review mechanism for the 
Commonwealth, enabling payment for only those treatments and services that are medically necessary, 
appropriate, and cost effective.

This job aid describes how to:
*	Inquire on a prior authorization to view the decision status
*	Inquire on a prior authorization to view paid claims


Inquire on a Prior Authorization to View the Decision Status

In this section, you will inquire on a prior authorization request to see whether it has been approved, denied, 
modified, or deferred. In addition, you will:

*	View the reason code
*	View external text

Access Prior Authorization 
On the MassHealth Member and Provider Services home page:
1.	Click Prior Authorization.
2.	Click Information. The Prior Authorization Search panel is displayed.
Search for the PA by Tracking Number
On the Prior Authorization Search panel:
3.	Enter the Tracking Number.
4.	Click Search. 
Select Tracking Number
On the Search Results panel:
5.	Click on the Tracking #. The Prior Authorization Information panel is displayed.
View General Details
On the Prior Authorization Information panel:
6.	Review the general details for the prior authorization request.
7.	Scroll down to the Prior Authorization Maintenance panel.
Select Line Item
On the Prior Authorization Maintenance panel:
8.	Click Line Item. The Line Item panel is displayed.

View Decision Status
On the Line Item panel:
9.	View the status in the Decision Status column. The decision status indicates whether the PA request 
has been approved, deferred, modified, or denied. 
       Note: Reason codes are added for requests that have been denied, deferred, or modified.
10.	Click on the Line Item to view the reason code.
View Reason Code
On the Reason Code panel:
11.	View the Reason Code and well as the Reason Description.
12.	To view the longer description, click on the Reason Code.
     Note: If the request was denied, modified, or approved, you are able to view the external text that was 
included on the notice sent to the member and provider.
13.	Scroll up to the Prior Authorization Maintenance panel.
Select External Text
On the Prior Authorization Maintenance panel:
14.	Click External Text.
Select Line Item
On the External Text  panel:
15.	Click on the Line Item.
View Description
On the External Text Maintenance panel:
16.	View the reason in the Description field. 
17.	Scroll up to the Prior Authorization Maintenance panel.
18.	Click Cancel All to proceed.    



Inquire on a Prior Authorization to View Paid Claims

In this section, you will learn how to inquire on a prior authorization to see what amounts have paid on the claim.

Access Prior Authorization 
On the MassHealth Member and Provider Services home page:
1.	Click Prior Authorization.
2.	Click Information. The Prior Authorization Search panel is displayed.
Search for the PA by Tracking Number
On the Prior Authorization Search panel:
3.	Enter the Tracking Number.
4.	Click Search.
Select Tracking Number
On the Search Results panel:
5.	Click on the Tracking Number.
View PA Request
On the Prior Authorization Information panel:
6.	Review general details for the prior authorization request.
7.	Scroll down to Prior Authorization Maintenance.
Select Claims List
On the Prior Authorization Maintenance panel:
8.	Click Claims List.
View Claim List
On the Claim List panel:
9.	View the claims that have paid against the prior authorization as well as the dollars paid by ICN.
      Note: To view a claim, search by ICN within the Claims functional area.
10.	Click Cancel All to proceed.

NewMMIS Job Aid: Inquire on a Prior Authorization Request
MassHealth Member and Provider Services	1 of 3	Revised: July 26, 2010
		v2.1

Provider Online Service Center - Submit a Referral
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