Prior authorization is not required for the diagnoses and treatments related to COVID-19 or known or suspected of having a COVID-19 contraction. Such prior authorization requirements will be reinstated as outlined below:
- Tufts Health Freedom Plan, Rhode Island Commercial plans and Senior Products: Effective for dates of service on or after August 7, 2021
- Tufts Health RITogether: Effective for dates of service on or after October 1, 2021
- Massachusetts Commercial plans, Tufts Health Direct, Tufts Health Together and Tufts Health Unify: Prior authorization will continue to be waived
As a reminder, urgent/emergent admissions are never subject to prior authorization.
Refer to the In Person, COVID-19 Treatment section above for ICD-10 codes to be present for the diagnosis and treatment of COVID-19.
Effective for dates of service on or after August 7, 2021, Tufts Health Plan has reinstated prior authorization and notification for non-hospital locations for post-acute care (i.e. inpatient rehab, LTAC, skilled nursing facilities and home care), including following an inpatient hospital admission for all products, with the exception of Tufts Health RITogether.
For all other services, unrelated to the diagnosis and treatment for COVID-19, prior authorization requirements are in effect, for all Tufts Health Plan products and pre-COVID-19 processes should be followed, with the exception of Tufts Health RITogether. Tufts Health RITogether continues to waive prior authorization for medical services through September 30, 2021 and Behavioral Health services through December 31, 2021.