Prior Authorization

(A) The MassHealth agency requires the surgeon to obtain prior authorization for services that are designated "P.A." in Subchapter 6 of the Freestanding Ambulatory Surgery Center Manual. No payment will be made for such services unless prior authorization has been obtained from the MassHealth agency before the delivery of service. The MassHealth agency will not grant retroactive prior-authorization requests. (B) Prior authorization determines only the medical necessity of the authorized service and does not establish or waive any other prerequisites for payment such as, but not limited to, member eligibility or resort to health insurance payment. (C) MassHealth regulations about prior-authorization requirements may be found in the individual program regulations for dentists, podiatrists, and physicians at 130 CMR 420.000: Dental, 424.000: Podiatrist, and 433.000: Physician, respectively.