Prior authorization

Here, in one convenient place, you’ll find the prior authorization materials that you may need to reference to provide care for our members. We recommend using our secure portals to conduct referral and authorization transactions, as well as a host of other convenient self-service functions.
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Our Navigating the Prior Authorization Process Quick Reference Guide is here to help make the PA process easier. This step-by-step resource gives you and your office staff helpful tips and guidance for submitting prior authorization requests smoothly and efficiently.

View the guide

Medical Necessity Guidelines

Access our prior authorization policies and medical necessity guidelines for both legacy brands in one convenient spot.

Medical Drug MNGs

Find detailed coverage criteria for medical benefit drugs for Harvard Pilgrim Health Care and Tufts Health Plan.

Vendor Programs

Reference information on our vendor partners who conduct utilization mangement for certain services.

Authorization resources

Our prior authorization and notification grids offer a handy overview.

Fax for medical PA

Refer to this chart for the updated FAX lines for submitting medical prior authorization requests.