What is the purpose of prior authorization (PA)?
MassHealth determines the medical necessity of a service or product to be provided to its members through the use of prior authorization (PA) See 130 CMR 450.303. PA determines only the medical necessity of the authorized service and does not establish or waive any other prerequisites for payment (such as a referral or preadmission screening (PAS)). A provider must submit a PA request in accordance with instructions provided by MassHealth for requesting PA in Subchapter 5 of the provider manual.
Related Questions
- I need to request a prior authorization for a physician in a group practice. Do I use the groups NPI or the physicians NPI when requesting the PA?
- What do I do about a prior authorization (PA) opened under an existing API/NPI when I enroll with a new NPI?
- What is the purpose of prior authorization (PA)?
