guide
MassHealth prior authorization: where and how to submit
MassHealth prior authorization requests go to MassHealth electronically, through its Provider Online Service Center (POSC), unless the member’s ACO or MCO covers the service. MassHealth, Massachusetts’ Medicaid and CHIP program, had 1,938,376 members as of November 30, 2025, according to its enrollment summary.
Since January 1, 2026, MassHealth decides standard requests within seven calendar days and expedited ones within 72 hours, according to its prior authorization process changes page. Paper requests are accepted only from a provider with an approved electronic claims waiver.
“Our collaboration with Silna has allowed our front desk team to focus on the needs of our families.”Holly L., Operations ManagerSilna prepares and submits each MassHealth request for your team.Get started
At a glance
- A member’s ACO or MCO authorizes the services that plan covers.
- Drug requests go to the MassHealth Drug Utilization Review Program.
- A deferred request with no new information in 14 calendar days is denied.
- Approval covers medical necessity only, and eligibility is checked separately.
- ABA requests use the Massachusetts standard ABA form, for up to 6 months.
Fee-for-service, ACO and MCO members
For services a member’s Accountable Care Partnership Plan or MCO covers, the member’s plan is responsible for authorizing them, and questions about its requirements go to that plan, according to MassHealth’s guide for ACOs, MCOs and Community Partners. Fee-for-service requests go to MassHealth through the POSC.
| Coverage | Who authorizes | Where the request goes |
|---|---|---|
| MassHealth fee-for-service | MassHealth | The POSC |
| Accountable Care Partnership Plan or MCO | The member's plan | The plan's own process |
| Drugs | MassHealth Drug Utilization Review Program | MassHealth's pharmacy PA forms |
For members moving from a managed care plan to fee-for-service, MassHealth intends to transfer the plan’s prior authorization approvals into its fee-for-service system, according to All Provider Bulletin 417 (July 2026). Providers confirm an approval by looking up the member’s MassHealth ID in the POSC.
Submitting through the Provider Online Service Center
MassHealth requires providers to send prior authorization requests electronically, through the POSC, according to its prior authorization FAQs. Paper requests on the PA-1 form are accepted only from a provider with an approved MassHealth electronic claims waiver. Some services also need a provider-specific form, such as an invoice, and Subchapter 5 of your provider manual lists the requirements.
Under 130 CMR 450.303, prior authorization determines only the medical necessity of the service and does not establish other prerequisites for payment, such as member eligibility. For questions, call MassHealth Customer Service for Providers at (800) 841-2900.
Services that need MassHealth approval
MassHealth’s FAQs list the service categories that need prior authorization. They include:
- Adult day health and adult foster care
- Day habilitation
- Durable medical equipment
- Home health
- Hearing instruments
- Physician services and vision care
- Personal care attendant services
- Therapy services: occupational, physical and speech/language therapy
Dental services are administered by DentaQuest.
Drug requests and the 24-hour rule
Drug requests go to the MassHealth Drug Utilization Review Program, using the forms on MassHealth’s Prior Authorization Forms for Pharmacy Services page, according to its drug prior authorization page. Under 130 CMR 450.303(A)(1), MassHealth acts on a pharmacy request within 24 hours and authorizes at least a 72-hour supply of a prescription drug where federal law requires. That rule still applies to drugs after the January 2026 changes, which cover medical items and services.
Silna handles prior authorizations under medical and behavioral health benefits. It does not submit pharmacy-benefit requests to pharmacy benefit managers.
ABA requests on the state’s standard form
Massachusetts publishes a standard form for ABA prior authorization requests, the Massachusetts Standard Form for Applied Behavior Analysis Services Prior Authorization Requests (September 2023), posted on mass.gov. It covers a request for evaluation, initial services, continued services or an amended request for continued services.
The authorization period may not exceed 6 months. The licensed applied behavior analyst completes the form, and a diagnostic report goes with requests for initial evaluations.
Decision times and deferrals since January 2026
Since January 1, 2026, MassHealth decides standard requests for medical items and services within seven calendar days of receipt, provided all necessary documentation is included, and expedited requests within 72 hours, under the CMS Interoperability and Prior Authorization Final Rule. A changed procedure date doesn’t qualify a request as expedited. The POSC’s PA Classification field marks each request as standard or expedited.
A deferral for missing documentation can extend review by up to 14 days. The provider has 14 calendar days from the deferral to send the information, and a request without it is denied, according to MassHealth’s FAQs.
In 2025, MassHealth fee-for-service reported approving 85.44% of standard requests for items and services other than drugs, with a median decision time of 1 day 23 hours, in its Calendar Year 2025 Prior Authorization Metrics. The same report shows that 78.78% of requests whose review was extended by a deferral were later approved.
- 85.44%
- standard requests approved in 2025
- 78.78%
- deferred requests later approved in 2025
For a denied request, see the guide to appealing a prior authorization denial.
What Silna handles on MassHealth requests
Silna checks which plan reviews each patient’s request, submits it with the documents it needs and follows up until a decision comes back. It also checks that each patient’s plan is still active and flags new insurance plans. G2 reviewers rate Silna 4.8 out of 5 across 66 verified reviews.
“We’re no longer finding out that a child’s coverage changed six weeks after the fact. We know before the session happens.”Mellanie Page, EVP of Operations, ABS KidsSilna flags each patient whose MassHealth plan changes.Get started
Key terms
- POSC
- The Provider Online Service Center, MassHealth's portal for electronic prior authorization requests.
- Fee-for-service
- MassHealth coverage that MassHealth reviews and pays directly.
- Deferral
- MassHealth's request for missing information, which can extend review by up to 14 days.
- Accountable Care Partnership Plan
- A MassHealth ACO plan that authorizes the services it covers for its members.
Frequently Asked Questions
Is there a MassHealth prior authorization form?
Requests go through the POSC, and the paper PA-1 form is only for a provider with an approved electronic claims waiver. ABA requests use the Massachusetts standard ABA form.
How long does MassHealth take to decide?
Seven calendar days for a standard request with all its documentation, and 72 hours for an expedited one. Drug requests are acted on within 24 hours.
Who handles prior authorization for an ACO or MCO member?
The member’s Accountable Care Partnership Plan or MCO, for the services it covers. Questions about its requirements go to that plan.
What happens if MassHealth defers a request?
It waits for the missing documentation. If nothing arrives within 14 calendar days of the deferral, MassHealth denies the request.
This article is general educational information and does not give medical, legal or insurance advice. MassHealth can change its requirements, so confirm them on mass.gov before you rely on this guide.
About the author
Jeffrey Morelli
Jeffrey Morelli is the Co-Founder and CEO of Silna Health, the first Care Readiness Platform built to remove the administrative barriers that delay care. Silna automates benefit checks, eligibility, and prior authorizations across 1,000+ payors, and is backed by $27M from Accel and Bain Capital Ventures. Before Silna, Jeff spent a decade in San Francisco building and scaling products for highly regulated industries, including leading go-to-market at Truework (Series C, acquired by Checkr).
Last updated: November 4, 2026.