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Network Health


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):

  • Pharmacy services, including specialty pharmacy drugs — fax a completed coverage determination request to us at 617-673-0956 or call us at 888-257-1985
  • Medical and behavioral health services — fax a completed prior authorization request to 781-393-2607, or call our Tufts Health Unify team at 888-257-1985
  • Advanced radiology imaging services — contact National Imaging Associates (NIA), 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:

Tufts Health Plan – 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 Tufts Health Plan – Network Health members on the date of service.

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