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MassHealth Prior Authorization Form

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The document outlines the process for submitting a Prior Authorization Request to MassHealth, emphasizing that approvals are based solely on medical necessity. It details the required information from both members and providers, including personal details, diagnosis, treatment descriptions, and service codes. The document also includes instructions for completing the form and mailing it to MassHealth for review.

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See more MassHealth Prior Authorization Form versions

We've got more versions of the MassHealth Prior Authorization Form form. Select the right MassHealth Prior Authorization Form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (80 Votes)
2015	4.3 Satisfied (32 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who requires a prior authorization?

Prior authorizations are usually only required for more costly, involved treatments where an alternative is available. For instance, if a physician prescribes an invasive procedure such as orthopedic surgery, it will likely require preauthorization.

What are prior authorization forms?

Prior authorization requires your doctor or provider to obtain approval from your health plan before providing health care services or prescribing prescription drugs. Without prior authorization, your health plan may not pay for your treatment or medication. (Emergency care doesnt need prior authorization.)

What is a prior authorization in simple terms?

Prior authorization means that a health provider needs to get approval from a patients health plan before moving ahead with a treatment, procedure, or medication. Different health plans have different rules for when prior authorization is required.

What does a prior authorization form do?

PAs are used by Medi-Cal to help ensure that necessary medical, pharmacy, or dental services are provided to Medi-Cal recipients and that providers are reimbursed appropriately. PAs are confidential documents and the information included on them is protected by state and federal privacy laws.

Do I need prior authorization for every refill?

When your prescription is authorized, it is approved for a limited time, usually six months or up to a year. You wont need to submit a new request with every prescription refill. Before the prior authorization runs out, you will get an alert.

What is the prior authorization program for CMS?

Prior authorization and pre-claim review are similar, but differ in the timing of the review and when services can begin. Under prior authorization, the provider or supplier submits the prior authorization request and receives the decision before services are rendered.

Why do you need a prior authorization?

Although prior authorizations can be used to manage prescription drug costs, they may also improve patient outcomes by ensuring appropriate use and minimizing harmful drug interactions, adverse events, and/or off-label use for diagnoses that lack evidence to support use.

How long does prior authorization take for medication at MassHealth?

It typically takes 24 to 72 hours. You may check the status of your prior authorization request on the prior authorizations page. You may also contact your doctors office directly.

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