Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111

MassHealth
Podiatry Bulletin 10
August 1999

TO:      Podiatrists Participating in MassHealth

FROM:      Mark E. Reynolds, Acting Commissioner

RE:      New Address for Prior Authorization Requests for Drugs

Background                     In the continuing effort to manage the pharmacy program in a clinically appropriate and cost-effective manner, the Division of Medical Assistance
(“the Division”) is contracting with the University of Massachusetts Medical School (“UMass”) to process all prior authorization requests for drugs, including those drugs that are administered in the physician’s office.  UMass currently administers the Drug Utilization Review Program for the Division.

New Address                    Effective 9/6/99, submit requests for all injectable, infusable, and oral for  PAs for                      drugs or biologicals (such as Hyalgan) that require prior authorization to Drugs Only                       the following address.

University of Massachusetts Medical School
DUR Program Offices
11 Midstate Drive
Auburn, MA 01501

Telephone: (508) 721-7171
Fax:             (508) 721-7138

NOTE:  Send only prior-authorization request for drugs, including
Hyalgan, to UMass.

PA Procedures                  Prior authorization for drugs and biologicals dispensed by a pharmacy for Drugs                           must be requested by the prescribing provider.  The prescribing provider Dispensed by                    must complete a Request for Prior Authorization form or submit a written a Pharmacy                       request on his or her letterhead containing the information required in
the billing instructions in Subchapter 5 of his or her provider manual.  The request must include the name, address, and telephone number of the pharmacy that will fill the prescription.

MassHealth
Podiatry Bulletin 10
August 1999
Page 2

Drugs Dispensed               For drugs that you dispense in your office, complete a Request for Prior
in the Office                          Authorization form as described in the billing instructions in Subchapter 5 of your provider manual.  The request must contain the servicing provider number of the individual practitioner who will be performing the procedure.  Do not enter the group-practice provider number (the
seven-digit number beginning with 97).

NOTE:  This instruction applies only when you are requesting prior authorization and does not change the way in which you enter provider numbers on the claim form.

Supplies of the                  To obtain supplies of the Request for Prior Authorization form, mail or fax
PA Form                            a written request to the following address or fax number. Unisys
ATTN: Forms Distribution
P.O. Box 9101
Somerville, MA  02145
Fax:  (617) 576-4087

Questions                         If you have any questions about the information in this bulletin, please contact the Unisys Provider Services Department at (617) 628-4141 or 1-800-325-5231.