Utilization Management Programs

Mass Advantage members with complex needs are identified and stratified for care management programs to improve health outcomes. Members engage with these wraparound programs after and between acute care episodes. Mass Advantage care managers collaborate with providers, vendors, and community resources to keep members living safely at home.

Authorization Requirements, Part B and Part C prior authorization request forms, Mass Advantage Authorization Code List, Prior Authorization Requests for Part D Drugs.

Referrals are NOT required for Mass Advantage HMO Basic, HMO Plus, and Premiere PPO plan products.