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Home > Providers > News Center > Network Matters > Network Matters Archives > September 2010 > New prior authorization form for bariatric surgery

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

September 2010

New prior authorization form for bariatric surgery  


Beginning November 15, 2010, providers requesting authorization for bariatric surgery services must submit a completed Bariatric Surgery Request for Prior Authorization form. This new form will be available in the Provider Manual on November 15, 2010. If incomplete forms or requests without the form are submitted, providers will be notified by phone or fax to re-submit their authorization requests. Please note that the Bariatric Surgeries Medical Review Criteria have not changed.

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