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Authorization

Use this supplemental form as a cover sheet for the standardized Mass Collaborative form.

Use this form ONLY for habilitative services. Habilitation services are defined as health care services that help a person keep, learn, or improve skills and functioning for daily living.

Please do not use this form for members in long-term care requiring physical, occupational, or speech therapy. For authorization instructions, visit Outpatient Rehabilitation Therapy.

Use this supplemental form as a cover sheet for the standardized Mass Collaborative form.

Use this supplemental form as a cover sheet for the standardized Mass Collaborative form.

Please file this form one week prior to the last covered service. For more instructions on how to complete the form, refer to our Guide.