Behavioral Health - Level of Care Request Form

Tufts Health Public Plans Products

Providers for Tufts Health Direct, Tufts Health Together and Tufts Health Unify must complete the Behavioral Health - Level of Care Request Form to submit outpatient prior authorization requests as outlined below.
 

Tufts Health Together and Tufts Health Direct
Tufts Health Together and Tufts Health Direct providers may submit the Behavioral Health - Level of Care Request Form via the secure Provider portal. Note: Immediate approval is obtained via the secure Provider portal if clinical criteria are met.

Providers may also complete the Behavioral Health - Level of Care Request Form and submit using one of the following channels:
 

Fax:      888.977.0776
Mail:     705 Mt. Auburn Street
             Watertown, MA 02471-9194
             Attn: Behavioral Health Intake Team

Tufts Health Unify
Providers may complete the Behavioral Health - Level of Care Request Form and submit using one of the following channels:

Fax:      857.304.6304
Mail:     705 Mt. Auburn Street
             Watertown, MA 02471-9194
             Attn: Tufts Health Unify Intake Team

Note: Tufts Health Unify providers do not have the option to submit the Behavioral Health - Level of Care Request Form via the secure Provider portal at this time.