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What does needing prior authorization mean?

Prior authorization is a process by which a medical provider (or the patient, in some scenarios) must obtain approval from a patient's health plan before moving ahead with a particular treatment, procedure, or medication. Different health plans have different rules in terms of when prior authorization is required.

What is a prior authorization and why do you need it?

A prior authorization (PA), sometimes referred to as a \u201cpre-authorization,\u201d is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.

What triggers a prior authorization?

When it comes to a medication prior authorization, the process typically starts with a prescriber ordering a medication for a patient. When this is received by a pharmacy, the pharmacist will be made aware of the prior authorization status of the medication. At this point, they will alert the prescriber or physician.

What is a Precert in healthcare?

A health plan may require that you meet specific criteria before a medical procedure or prescription drug is covered. The process of determining coverage is known as precertification. It's a way for the insurance carrier to manage costs and make sure they aren't paying for something that is unnecessary.

How do I submit prior authorization to MassHealth?

To request a provider manual or PA forms, call MassHealth Customer Service at (800) 841-2900, fax to (617) 988-8973, email to publications@mahealth.net, or write to the following address.

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