Health Care Access Bureau And Bureau Of Managed Care, Division Of Insurance Prior Authorization Lookup
- Health Care Access Bureau And Bureau Of Managed Care, Division Of Insurance coverage criteria
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Latest Health Care Access Bureau And Bureau Of Managed Care, Division Of Insurance prior authorization updates9
- Prior AuthClinical/Medical PolicyEff. 2020-04-09Coverage for COVID-19 Treatment and Out-of-Network Emergency and Inpatient Reimbursement During the COVID-19 Health CrisisDirects Massachusetts commercial carriers and HMOs on coverage, cost-sharing waivers, prior authorization, and payment rates for medically necessary testing and treatment of COVID-19 during the Commonwealth's emergency order; applies to commercial insurers, Blue Cross and Blue Shield of Massachusetts, Inc., and HMOs.All Health Care Access Bureau and Bureau of Managed Care, Division of Insurance updates
- Prior AuthReimbursement/Payment PolicyEff. 2020-04-09Updated Guidance Regarding Coverage and Reimbursement for Out-of-Network Emergency, Ambulance and Inpatient Services During the COVID-19 Health CrisisGuidance to Massachusetts commercial insurers, Blue Cross and Blue Shield of Massachusetts, and HMOs on coverage, reimbursement, prior authorization, and balance-billing rules for COVID-19-related emergency, inpatient, ambulance, rehabilitation and home health services during the public health emergency and under Chapter 260/Order No. 61.All Health Care Access Bureau and Bureau of Managed Care, Division of Insurance updates
- Prior AuthAdministrative/Operational PolicyEff. 2020-03-30Credentialing and Prior Authorization during COVID-19 (Bulletin 2020-10)Directs commercial health insurers and HMOs to expedite credentialing and suspend or modify prior authorization requirements to ensure timely access to COVID-19 testing, treatment, inpatient transfers, home health, and post-acute placement during the public health emergency.All Health Care Access Bureau and Bureau of Managed Care, Division of Insurance updates
- Prior AuthClinical/Medical PolicyEff. 2020-03-16Emergency Measures to Address and Stop the Spread of COVID-19 — Telehealth Access, Prior Authorization and Reimbursement GuidanceDirects Massachusetts commercial carriers and HMOs to expand telehealth access, waive prior authorization and cost-sharing for telehealth COVID-19 treatment, allow audio-only modalities, and require reimbursement parity and appropriate documentation during Governor Baker's Emergency Order.All Health Care Access Bureau and Bureau of Managed Care, Division of Insurance updates
- Prior AuthClinical/Medical PolicyEff. 2020-03-06Addressing COVID-19 (Coronavirus) Testing and TreatmentThis Bulletin sets the Division of Insurance's expectations for Massachusetts commercial health carriers regarding coverage, cost-sharing, prior authorization, network flexibility, and member communication for medically necessary testing and treatment related to COVID-19, affecting carriers and their covered members in Massachusetts.All Health Care Access Bureau and Bureau of Managed Care, Division of Insurance updates
- Prior AuthClinical/Medical PolicyEff. 2015-05-01Access to Services to Treat Substance Use Disorders (acute treatment and clinical stabilization; preauthorization rules)Governs insured health plans issued, delivered or renewed in Massachusetts and requires coverage and limits on preauthorization for medically necessary substance use disorder services and abuse-deterrent opioids; affects carriers, DPH-certified/licensed providers, and plan members.All Health Care Access Bureau and Bureau of Managed Care, Division of Insurance updates
- Prior AuthClinical/Medical PolicyBulletin 2024-03 — Step Therapy Protocols and Standardized Medication Prior Authorization FormsBulletin 2024-03 governs Massachusetts carriers' obligations for step therapy protocols, required exception processes, timelines for determinations, continuity of coverage, and standardized prior authorization forms for medications; it applies to commercial health insurers and HMOs offering insured products in Massachusetts.All Health Care Access Bureau and Bureau of Managed Care, Division of Insurance updates
- Prior AuthAdministrative/Operational PolicyContinued Access to Care for Covered Persons Impacted by the Closing of Carney Hospital and Nashoba Valley Medical CenterThis bulletin directs Massachusetts commercial health insurers, HMOs, and Blue Cross Blue Shield of MA to relax prior authorization and credentialing processes and assist covered persons affected by the closures of Carney Hospital and Nashoba Valley Medical Center to ensure continued access to care.All Health Care Access Bureau and Bureau of Managed Care, Division of Insurance updates
- Prior AuthClinical/Medical PolicyCoverage for COVID-19 (SARS-CoV-2) testingThis bulletin sets the Division of Insurance expectations for commercial carriers operating in Massachusetts about coverage, prior authorization, cost-sharing, and related requirements for COVID-19 PCR, antigen, and antibody testing for insured members.All Health Care Access Bureau and Bureau of Managed Care, Division of Insurance updates
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Tool Description
Search Health Care Access Bureau And Bureau Of Managed Care, Division Of Insuranceprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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