There are some services for which health plans require providers to follow prior authorization procedures before a service will be covered. To view each health plan's prior authorization guidelines, please follow the links below.

Generic Prior Authorization Form:

The following health plans have agreed to accept a generic prior authorization form.
To view/download the generic form, please click here:

• Fallon Community Health Plan
• Neighborhood Health Plan
• Network Health
• Tufts Health Plan (some procedures will require additional clinical information)