Prior Authorization

(A) The IDTF must obtain prior authorization for services that are designated "P.A." in the service descriptions listed in Subchapter 6 of the Independent Diagnostic Testing Facility Manual. (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 member eligibility or resort to health insurance payment. (C) All requests for prior authorization must be submitted in accordance with the instructions found in Subchapter 5 of the Independent Diagnostic Testing Facility 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.