Tufts prior authorization form 2025

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The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patients insurance provider.
Prior authorization for certain services, drugs, devices and equipment is based on Tufts Health Public Plans medical necessity guidelines (MNGs) or InterQual criteria. Any request for services provided by out-of-network (OON) providers requires prior authorization.
If you have any questions, call Tufts Health Plan Medicare Preferred Member Services at 1-800-701-9000 (HMO) or 1-866-623-0172 (PPO) (TTY: 711).
The Prior Authorization Process Flow The healthcare provider must check a health plans policy or prescription to see if Prior Authorization is needed for the prescribed treatment. The healthcare professional must sign a Prior Authorization request form to verify the medical necessity claim.
The most common reason in my experience why PA requests get denied, is quite simply a lack of information. For example, its very common for PA requests for MRIs or CTs to require that an X-ray and/or ultrasound be done first, to see if that will provide enough information for the doctor to treat the issue.
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The patient or their representative can contact their insurance company and provide the relevant information to start the Prior Authorization process. Its best to confirm with the healthcare provider if they have the information and are willing to submit the request.

tufts prior authorization form pdf