BCBS AFFILIATEMAPBM: Express Scripts
Blue Cross Blue Shield of Massachusetts Prior Authorization Guide
Submit prior authorization requests and appeal denials with BCBS Massachusetts. Phone numbers, fax numbers, appeal deadlines, step therapy override rights, and clinical documentation tips for MA providers.
Prior Authorization Contacts
PA PHONE
1-800-366-7778
PA FAX
1-888-282-0780
TURNAROUND
14 days standard, 72h expedited
TIMELY FILING
60 days
APPEALS MAILING ADDRESS
BCBS Massachusetts, Attn: Member Appeals, PO Box 986046, Boston, MA 02298
Common Denial Reasons
- ⚠ Not meeting BCBS-MA Medical Policy criteria
- ⚠ Step therapy required
- ⚠ Massachusetts Prescription Drug Cost Containment rules
- ⚠ Site of care requirement
Step Therapy Requirements & Override Rights
Massachusetts Chapter 255 of Acts 2012 and subsequent laws require health plans to follow clinical guidelines. BCBS MA generally requires TNF inhibitor trial before approving non-TNF biologics. MA has strong patient protection laws for step therapy overrides.
Tips for BCBS Massachusetts Submissions
- 1. BCBS-MA has one of the most structured PA processes â follow Medical Policy to the letter
- 2. Reference policy number exactly as listed in Medical Policy portal
- 3. Submit via the Availity portal
- 4. MA step therapy override requires insurer response within 72 hours
External Review Authority
If BCBS Massachusetts denies your final internal appeal, you have the right to request an external review through: Massachusetts Office of Patient Protection (OPP).
External review decisions are binding on the insurer.