If you provide maternity health care services to our members, we’d like to remind you that as outlined in the Harvard Pilgrim Health Care Commercial and Tufts Health Plan Commercial prior authorization and notification requirements, obstetrical admissions that result in the delivery of a newborn do not require inpatient notification.

Please keep in mind, however, that if you have a patient who requires acute inpatient hospitalization due to a complication of pregnancy and not a planned delivery, prior authorization is required. To learn more about prior authorization requirements, please refer to Point32Health’s Inpatient Acute and Post-Acute Levels of Care Medical Necessity Guidelines.

As always, we encourage you to submit prior authorization requests electronically through our HPHConnect and Tufts Health Plan secure provider portals. While electronic submission is preferable, we also accept faxed requests (to the number noted on the Medical Necessity Guidelines). Additional direction for submitting prior authorization requests can be found within our secure portal user guides in the Provider training guides section of our website.