We require prior authorization before you send someone to see one of our:
- Nonpreferred in-network providers (except for emergency services and post-stabilization care)
- Out-of-network providers (except for emergency services and urgent care)
To check which providers require prior authorization, please see our Provider Directory.
We also require prior authorization for:
- Certain covered services (e.g., inpatient admissions or some types of surgery)
- Home health care
- Durable medical equipment
- Certain behavioral health services
- Certain drug authorizations
- 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 Network Health patient is in our records as part of your panel before rendering services. We require prior authorization for services rendered to a Network Health patient who is not in your panel.
How to request authorizations
To request behavioral health service authorizations, please contact our behavioral health team.
To request most drug authorizations, please contact MedImpact, our pharmacy benefit manager. To request specialty medications, please contact Caremark, our specialty pharmacy program manager.
To request advanced radiology imaging service authorizations, please contact MedSolutions, an organization that specializes in managing diagnostic services.
To request other authorizations, please fill out the appropriate form and fax or mail it to us at:
Attn: Medical Management
101 Station Landing, Fourth Floor
Medford, MA 02155
If an authorization is urgent
For urgent authorization needs, please call us at 888-257-1985. Approval depends on eligibility on the date of service and other determining factors. Remember to check eligibility on the date of service. We do not pay for services rendered to patients who were not Network Health members on the date of service.
For more information
Please see our Provider Manual for complete details of our authorization process or call us at 888-257-1985.