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Tufts prior authorization form

Tufts prior authorization form 2025

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The document is a request form for pharmacy prior authorization review by Tufts Health Plan, specifically for their Medicare Preferred HMO, PDP, and Senior Care Options programs. It includes sections for patient and prescriber information, requested drug details, clinical justification, and options for expedited review. The form aims to facilitate the approval process for medications requiring prior authorization.

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Click ‘Get Form’ to open the Tufts Prior Authorization Form in the editor.
Begin by filling out the 'Patient Information' section. Enter the patient's name, date of birth, member ID, and relevant diagnoses.
Next, complete the 'Prescriber Information' section. Include your name, specialty, Tufts Health Plan Provider ID, phone number, and office contact details.
In the 'Requested Drug' section, specify the drug name and strength. Choose between 'Dispense As Written' or 'Generic Substitution Authorized'.
If applicable, answer questions regarding expedited review and long-term care residency. Provide justification for your request in the 'Clinical Justification for Request' section.
Finally, ensure you sign the form where indicated and review all entries for accuracy before submitting.

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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 writes prior authorization?

The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patients insurance provider.

Does Tufts HMO require prior authorization?

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.

What is the phone number for Tufts Medicare 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).

Who handles submitting a request for prior authorization?

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.

How to obtain preauthorization for a patient?

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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How do I complete a prior authorization?

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 2025

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Got questions?

Who writes prior authorization?

Does Tufts HMO require prior authorization?

What is the phone number for Tufts Medicare prior authorization?

Who handles submitting a request for prior authorization?

How to obtain preauthorization for a patient?

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How do I complete a prior authorization?

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