Behavioral Health - Level of Care Request Form

Tufts Health Public Plans Products

Providers for Tufts Health Direct, Tufts Health Together and Tufts Health One Care 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:     1 Wellness Way
              Canton, MA 02021-1166
             Attn: Behavioral Health Intake Team

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

Fax:      857.304.6304
Mail:     1 Wellness Way
              Canton, MA 02021-1166
             Attn: Tufts Health One Care Intake Team

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