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Network Health


Authorizations

We require prior authorization before you send someone to see one of our nonpreferred in-network or out-of-network providers, except for emergency, poststabilization, and urgent care. To check which providers require prior authorization, see our Find a Doctor, Hospital, or Pharmacy tool.

We also require prior authorization for:

  • Certain covered services (e.g., inpatient admissions, some types of surgery)  
  • Home health care
  • Durable medical equipment
  • Certain behavioral health services
  • Certain medications
  • Advanced radiology imaging services

To check if a service is covered and/or requires prior authorization, please see our medical and behavioral health benefit summary grids.

Please note: If you are a primary care provider (PCP), make sure the patient is in our records as part of your panel before rendering services. We require prior authorization for services rendered to a Network Health member who is not in your panel.

How to request prior authorization

For members of Network Health Together (MassHealth), Network Health Direct (an individual and small-group plan), or Network Health Choice (an individual and small-group plan):

  • Pharmacy services, including specialty pharmacy drugs — fax a completed medication request form to us at 617-673-0988 or call us at 855-288-7570  
  • Medical services — fax a completed prior authorization request to 888-415-9055 or call our medical management team at 888-257-1985
  • Behavioral health services — fax a completed prior authorization request to 888-977-0776 or call our behavioral health team at 888-257-1985
  • Advanced radiology imaging services — contact MedSolutions, an organization specializing in managing diagnostic services 

For members of Network Health Forward (Commonwealth Care) and Network Health Extend:

  • Pharmacy services, including specialty pharmacy drugs — fax a completed medication request form to MedImpact at 877-501-1059 or 858-790-7100, or call us at 888-257-1985  
  • Medical services — fax a completed prior authorization request to 888-415-9055 or call our medical management team at 888-257-1985
  • Behavioral health services — fax a completed prior authorization request to 888-977-0776 or call our behavioral health team at 888-257-1985
  • Advanced radiology imaging services — contact MedSolutions, an organization specializing in managing diagnostic services 

For members of Network Health Unify (Medicare-Medicaid One Care for people ages 21 – 64):

  • Pharmacy services, including specialty pharmacy drugs — fax a completed coverage determination request to us at 617-673-0956 or call us at 855-288-7570 
  • Medical and behavioral health services — fax a completed prior authorization request to 781-393-2607 or call our Network Health Unify team at 888-257-1985
  • Advanced radiology imaging services — contact MedSolutions, an organization specializing in managing diagnostic services 

To request other authorizations, please fill out the appropriate form and fax or mail it to us at:

Network Health
Attn: Medical Management
101 Station Landing, Fourth Floor
Medford, MA 02155
888-415-9055 (fax)

If an authorization request is urgent
For urgent authorization needs, please call us at 888-257-1985.

Please check eligibility on the date of service; approval depends on eligibility and other determining factors. We do not pay for services rendered to patients who were not Network Health members on the date of service.  


888-257-1985
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