Log in to Network Health Connect now to check the status of an authorization.
We require prior authorization before you send someone to see one of our nonpreferred in-network or out-of-network providers, except for emergency, post-stabilization, 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, 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 Tufts Health Plan – Network Health member who is not in your panel.
How to request prior authorization
For members of Tufts Health Together (MassHealth) or Tufts Health Direct (an individual and small-group plan):
For members of Tufts Health Unify (Medicare-Medicaid One Care for people ages 21 – 64):
To request other authorizations, please fill out the appropriate form and fax or mail it to us at:
Tufts Health Plan – Network Health
Attn: Medical Management
101 Station Landing, Fourth Floor
Medford, MA 02155
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 Tufts Health Plan – Network Health members on the date of service.