Massachusetts: Start Here
Beginner guide for Massachusetts—Health Connector, OPP external review, PA deadlines, and what to open next.
Read guideState playbook
Massachusetts
State insurers, legislation, and appeal resources for patients and advocates in Massachusetts.
4 guides
Massachusetts Prior Authorization Law
c. 176O §§ 12, 25—2-day UR, 2-day PA form response, deemed granted if late, clinical peer reconsideration.
Read guideMassachusetts Health Insurance Appeals and Grievances
§ 13—30-day grievances, deemed resolved if late, expedited hospital/urgent paths, path to OPP § 14 review.
Read guideMassachusetts External Review (OPP)
Binding panel review—4-month filing, 45-day standard, 72-hour expedited, c. 176O § 14, OPP administers.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Blue Cross Blue Shield of Massachusetts
- Harvard Pilgrim Health Care
- Tufts Health Plan
- UnitedHealthcare
- WellSense Health Plan
- Massachusetts Health Connector
- MassHealth
External appeals
After internal appeal, for eligible Massachusetts fully insured plans only.
- OPP — External review
- Division of Insurance
- MassHealth — Fair hearing