You can now electronically request medication authorization for commercial members
When a medication requires prior authorization, you can now submit the Massachusetts Standard Form for Medication Prior Authorization Requests electronically with our new eForm. Enter information about your request directly into the form, hit the “submit” button, and your request is sent right to us. The eForm replaces the PDF version of the form.
The form is now standard for Massachusetts health insurers to meet the requirements of Chapter 224. It was developed with the Mass Collaborative, a partnership of payers, providers, and trade associations. We expect additional all-payer medication authorization forms to be made available in the future, and will let you know.
Important: You’ll need to allow enough time to fill out the form entirely since you cannot save it to fill out later.
Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.
There are three separate screens you’ll need to fill out:
Important: Use your usual process for Medicare Advantage and Federal Employee Program members. The system will not accept the “R” prefix with numbers for Federal Employee Program. It only accepts 3 letters with the 9 digits.
|Q:||Do I have to use the electronic version of the standard form, or can I continue to use the forms I currently have on my desktop for Blue Cross members?|
|A:||You should replace any forms you currently have on file and start using the electronic version of the Massachusetts Standard Form for Medication Prior Authorization Requests.
|Q:||Can I continue to call in authorization requests by phone?|
|A:||Yes, if you prefer calling in your prior authorization requests, you can continue to call our Clinical Pharmacy Operations area at 1-800-366-7778.
|Q:||Should I use the eForm if we’re buying and billing a medication and the medication has a prior authorization requirement?|
|A:||Yes, if the medication requires prior authorization, please use the eForm for medications that you administer and bill us for using the member’s medical benefits.
|Q:||What if I have an urgent request?|
|A:||Make sure to check the “Expedited Review/Urgent Request” box and we will expedite your request.
|Q:||Can I submit attachments to help support my request?|
|A:||Yes, you can. You’ll be prompted to upload any attachments. We accept files up to 5 MB in these formats: Pdf, doc, docx, xls, xlsx, csv, txt, bmp, gif, jpg/jpeg, png, and tiff.
|Q:||Do I need to fill out everything on the eForm?|
|A:||It’s very important that you fill out all required fields on the eForm and supply us with any relevant clinical information. We make authorization decisions based on the clinical information you submit on your form. Your request could be denied if we don’t have enough information.
|Q:||What do I do if my authorization request is denied?|
|A:||If we deny your authorization request, we’ll notify you. The letter that we fax to you will include information on what to do to appeal our decision. We don’t send these notifications by email.
|Q:||Why can’t I open the eForm?|
|A:||You may not be able to open or submit the eForm if you use a browser that’s not compatible. Internet Explorer 7, 8, 9, or Firefox work best.|
|Here’s what you might see if you aren’t using a supported browser (Internet Explorer 11 was used in this example.)
|Q:||How do I know what browser version I’m using?|
|A:||Usually you can find out what version of your browser you’re using by checking under the “Help” section of your browser and look for “About.” If you need to download a different version, check your browser’s website for instructions.
|Q:||I’m trying to sign the eForm, but the “Click to sign” button isn’t working. What’s wrong?|
|A:||When you enter the name of the prescribing clinician or authorized representative, you need to make sure you type “Enter” on your keyboard (or hit the “Tab” button on your keyboard). Then, you should be able to hit the “Click to sign” button.
|Q:||I want to make a change, but I already signed the eForm and it won’t let me make the change. What should I do?|
|A:||If you’ve already signed the eForm, you need to un-sign it before you can make a change. To do this:
If you have questions, contact Clinical Pharmacy Operations at 1-800-366-7778.