Prior authorization resources

We’ve developed the following lists and grids to provide guidance on services that require prior authorization and notification by Plan.

Harvard Pilgrim Health Care

Harvard Pilgrim Commercial Referral/Auth./Notification Quick Reference Guide

Harvard Pilgrim Health Care (New Hampshire only)

Harvard Pilgrim Health Care-NH Commercial Prior Authorization

Tufts Medicare Preferred

Tufts Medicare Preferred (HMO and PPO) Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines

Tufts Medicare Preferred (HMO and PPO) Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines (Eff. beginning 01.01.2027)

Tufts Health Senior Care Options

Tufts Health Plan Senior Care Options Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines

Tufts Health Plan Senior Care Options Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines (Eff. beginning 01.01.2027)

Tufts Health One Care

Tufts Health One Care Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines

Tufts Health One Care Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines (Eff. beginning 01.01.2027)

Tufts Health MATogether

Tufts Health MATogether-MassHealth ACO Prior Authorization

Tufts Health RITogether

Tufts Health RITogether Medicaid Prior Authorization

Behavioral Health

Tufts Health RITogether Behavioral Health Prior Authorization (PA) and Notification Grid

Tufts Health Together and Tufts Health Direct Behavioral Health Prior Authorization (PA) and Notification Grid

Tufts Health One Care Behavioral Health Prior Authorization (PA) and Notification Grid