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.
- Login to HPHConnect
- Login to Tufts Health Plan secure portal
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.
Pharmacy
Access pharmacy clinical coverage criteria and medication request forms.
Authorization resources
Our prior authorization and notification grids offer a handy overview.
Provider Manuals
Our Provider Manuals include additional information on authorization, notification and referrals.
Insights and Updates
Be sure to read our monthly newsletter for updates to policies and procedures.