Request prior authorization for nonpharmacy services

Are you a MassHealth nonpharmacy provider? Do you need a prior authorization (PA)? You can find and submit forms here. Send PA requests via the Provider Online Service Center (POSC).
We respond to complete submitted PA requests within 14-21 calendar days.

MassHealth Customer Service Center for Providers

The Details of Request prior authorization for nonpharmacy services

What you need for Request prior authorization for nonpharmacy services

You may have to submit a provider-specific form, such as an invoice, along with any required documentation. Please check Subchapter 5 of your provider manual for specific requirements.

We prefer that you submit requests online through the POSC.

 

How to request Request prior authorization for nonpharmacy services

How to request

Online

You can submit  a PA request through the POSC.


 

W

By mail

We prefer that you submit PA requests through the POSC.

To submit a paper PA request

1. Download the PA-1 request form  from the MassHealth website.

2. Mail the completed PA request form and attachments to the address listed on the form.

 

Next steps for Request prior authorization for nonpharmacy services

  1. Possible decisions

    Approve the request: we authorized the request.

    Deny the request: we denied the request and won’t reimburse for the service.

    Modify the request: we approve a service that is different in quantity or nature than your request. We determined that the approved item is appropriate to meet the medical needs of the member.

    Defer the request: we need more information to make a decision. We ask you to submit supporting documentation.

  2. What if the request is deferred?

    If we defer a PA, we send notification to both you and the member explaining why. The most common reason for deferral is missing documentation. You can submit the needed information within 30 days, either by attaching it to the online PA request or by mail. When we receive the required information, our review can continue.

  3. What if the request is modified or denied?

    If we modify or deny a PA, the member has a right to appeal the decision.

     

Contact for Request prior authorization for nonpharmacy services

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