Prior Authorization
Here, in one convenient place, you’ll find the prior authorizaton materials that you may need to reference to provide care for our members. We recommend using our secure portals (Tufts Health portal for Tufts Health Plan members or HPHConnect for Harvard Pilgrim commercial members) to conduct referral and authorization transations, as well as a host of other convenient self-service functions.
Medical Necessity Guidelines
Access our prior authorization policies and medical necessity guidelines for both legacy brands in one convenient spot.
Medical Drug MNGs
Find detailed coverage criteria for medical benefit drugs for Harvard Pilgrim Health Care and Tufts Health Plan.
Vendor Programs
Reference information on our vendor partners who conduct utilization mangement for certain services.
Pharmacy
Access pharmacy clinical coverage criteria and medication request forms.
Prior authorization resources
Our prior authorizaiton and notification grids offer a handy overview.
Insights and Updates
Be sure to read our monthly newsletter for updates to policies and procedures.