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The following links are to the approval requirements and medical criteria for certain services and benefits. In most cases, your provider will take care of authorization of services.
Behavioral health medical necessity criteria Medical criteria for behavioral health services
Dental claim utilization and review criteria (pdf) National standardized criteria to provide guidance for your clinical dental consultant
Diagnostic imaging services Prior authorization requirements for high-tech outpatient diagnostic imaging, such as CT scans, PET scans, MRIs and Nuclear Cardiac Imaging
InterQual medical necessity criteria Login to view the criteria Fallon Health uses to guide coverage determination decisions
Medical policies Policies for medical treatments
Pharmacy prior authorization documentation Covered prescription drugs that have prior authorization requirements
Sleep therapy Prior authorization requirements for sleep therapy, sleep studies and related supplies