• Guidelines for Medical Necessity Determination Overview

    The MassHealth Guidelines for Medical Necessity Determination (Guidelines) are used by MassHealth's reviewing clinicians to determine the medical necessity of prior-authorization requests submitted by providers.
  • Guidelines for Medical Necessity Determination: Email Notification

    Sign up to receive e-mail notification of updates to the MassHealth Guidelines. Note: When you click on the sign up link, a blank e-mail should appear.  If your settings prevent this, you may also copy and paste join-guidelines_for_medical_necessity_review_updates@listserv.state.ma.us into your e-mail address line.  Just send the blank e-mail as it's addressed. No text in the body or subject line is needed.
  • MassHealth Guidelines for Medical Necessity Determination

  • Medical Necessity Review Forms