MassHealth identified certain outpatient claims for drugs requiring prior authorization (PA), with dates of service on or after January 1, 2026, that were incorrectly denied for edit ‘3003-Procedure Code Requires PA’.
In the interim, a manual PA lookup process will be implemented, and affected claims will be adjusted and reflected on subsequent remittance advices until the permanent system automatic PA lookup is corrected in MMIS.
Once the permanent correction to the system automatic PA lookup is implemented in MMIS, affected claims will be re-adjusted as needed to accurately reflect PA utilization. These re-adjustments are expected to occur in early October 2026.
If you have questions regarding this message, please contact MassHealth at provider@masshealthquestions.com or (800) 841-2900.