This job aid describes how to enter a prior-authorization (PA) request via the Provider Online Service Center 
(POSC).
Access Enter a PA Request
From the POSC home page:
1.	Click Manage Service Authorizations.
2.	Click Prior Authorizations.
3.	Click Enter a PA Request. The Prior Authorization Templates panel is displayed.
Select Assignment Type
The assignment types are grouped into three categories: Basic Medical, Durable Medical Equipment, and 
Therapy Services.
On the Prior Authorization Templates panel:
4.	Select the Basic Medical Assignment Code from the drop-down list. There are two options:
*	PCA Services – adults 22 years old or older 
*	PCA Pediatric Services  
5.	Click the Continue button.

 
Search for and Select Requesting Provider
On the Base Information panel:
6.	Enter the NewMMIS Member ID. 
7.	Enter the member’s Height (optional).
8.	Enter the member’s Weight (optional).
9.	Select the Requesting Provider from the drop-down list.  
Note: This is the PCA/PCM Provider ID. The drop-down list displays provider IDs, service locations, 
NPIs (national provider identifiers), and names accessible to your login ID.
10.	Select Place of Service from the drop-down menu (optional).
11.	Enter the Primary/Secondary Diagnosis Codes (optional).  
Note: If desired, you can click the Field Search icon (   ) to perform a search for the correct diagnosis 
code.
12.	Enter Clinical Rationale (medical reason for PA).
13.	Enter Comments (non-medical explanation of PA).
14.	Click the Line Items tab.
 
Add a Line Item
On the List of Line Items panel:
15.	Click New Item.
On the Basic Medical Details panel:
16.	Enter the Procedure Code (for example, T1019).
17.	Enter Modifier 1 (for example, TV) if appropriate. 
Note: Please do not enter more than one modifier.
18.	Enter or click on the calendar icon to select the Requested Effective Date.
19.	Enter or click on the calendar icon to select the Requested End Date.
20.	Enter the number of Requested Units.
21.	Enter the Servicing Provider ID by either: 
*	Searching for the Servicing Provider by clicking the search icon. 
Note: The Servicing Provider is the fiscal intermediary (FI). There are three options:
CPMA              110027795 C
Stavros            110031119 B
NSARC            110026357 I
*	Entering the FI’s Provider ID and Location alpha character (for example, 123456789 A) in the 
Provider ID/Service Location field. 
22.	Click Add. 
 
Add an Attachment
23.	Click the Attachments tab. The List of Attachments panel displays.
24.	Click New Item. 
On the Attachment Details panel:
25.	Select the Report Type from the drop-down list. 
*	Initial Assessment – initial request
*	Patient Medical History Document - reevaluation 
*	Select the Transmission Code from the drop-down list. 
26.	Enter the FI’s provider ID/service location.
27.	Enter the Control Number (only if the transaction code is Available on Request at Provider Site).
28.	Enter a brief description of attachment in the Description field.
29.	Click Browse. The Open window displays.
30.	Navigate to the file you want to attach and click Open.
31.	Click Add/Upload.
32.	Click the Confirmation tab.
Note: If you add an attachment after submitting the PA Request, you must contact the PA Unit to notify 
them of the attachment.
 



Submit Request
33.	Click the Confirmation tab. 
On the Confirmation panel:
34.	Review the requested information to ensure that it is correct.
When you have made sure the request is correct:
35.	Click Submit. The Prior Authorization Response panel is displayed, indicating the request was 
successfully submitted.
	Note: A "PA not required" message is displayed on the POSC when entering a PA request for services 
that SOMETIMES require a PA. This is a so-called “soft edit” and WILL NOT PREVENT YOU FROM 
ENTERING THE PA. Click the Ignore checkbox to close this message. Please refer to Subchapter 6 of 
your MassHealth provider manual to determine if PA is required. The provider manual can be found 
at www.mass.gov/masshealthpubs. Click on Provider Library, then on MassHealth Provider Manuals. 
 
 

Glossary of PCM Terms
Adjudicate – There are header-level PA statuses to indicate where the PA request is in the process.  Adjudicated means
MassHealth has made a decision on the PA and that all lines have been finalized. Finalized is when all line statuses are 
cancelled, approved, modified, or denied. When the PA is adjudicated, a letter is sent to the member (with right to appeal for 
denied or modified lines), PCM, and FI.

Control Number – the number assigned by the PCM for an attachment that will be stored at the PCM office (only applies 
when Transmission Code is Available on Request at Provider Site).

Report Type – Documentation submitted with request by PCM. There are two options for PCM:
	Initial Assessment – initial request
	Patient Medical History Document - reevaluation 

Status – Indicates where the request is in the process of being reviewed and adjudicated. Status options:
	Additional Information Received – Indicates information has been received that was missing from the original 
request.
	Approved – The request is approved by MassHealth. A PA letter is generated and sent to the member, the PCM, 
and the FI.
	Cancelled – The request is cancelled by MassHealth due to duplication or insufficient information. A PA letter is 
generated and sent to the member, the PCM, and the FI with a reason for the cancellation. The PCM may resubmit 
the request as appropriate.
	Cancelled by Provider – The status used for all lines when the provider (PCM) voids the PA request. 
      Note:  A provider can void a PA only while the PA is in Ready for Review status.
	Denied – The request has been denied by MassHealth. A PA letter is generated and sent to the member (with right to  
appeal), and to the PCM and the FI.
	In Process – The request has only been saved, and has not been submitted to MassHealth for review.
	In Review – The request has been submitted by the PCM and assigned to a MassHealth reviewer. 
	Modified – The request has been altered by a MassHealth reviewer either in adjudicating or as an adjustment 
requested by the PCM. A PA letter is generated and sent to the member (with right to appeal), and to the PCM and 
the FI.
	Ready for Review – The request has been submitted, but has not been assigned to MassHealth reviewer.
	Testing – The request has been submitted in order to test functionality of the system.
	Void – The request has been voided by MassHealth. A PA letter is not generated.




Glossary of PCM Terms (continued)
Tracking Number – The number assigned to a PA request before MassHealth review.

Transmission Code – The method by which the PCM transmits an attachment to MassHealth. There are six code options:
	Available on Request at Provider Site
	By Fax
	By Mail
	Electronically Only
	E-mail
	Voice
Note: To inquire on, modify, or void a PA Request, please refer to the Inquire/Maintain a Prior Authorization for 
PCM job aid.
Deb, I agree this is unclear but the words refer to #21 and #22. Please see the Inquire job aid (item #32), the 
formatting used there made it much clearer.
What is supposed to appear after “Do one of the following:”?
This seems to be hanging here with no mention of the options. Is there something missing?
Nothing is missing, the provider would be on the system as he/she goes through these steps and would be on the 
panel below and would click the arrow to reveal the options – but I deleted the words (two options) as they really 
are not necessary.
NewMMIS Job Aid: Enter a Prior Authorization Request
for PCM (Personal Care Management)

MassHealth Provider Online Service Center	1 of 7	Revised: April 15, 2010
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