Retrospective Review Authorization Policy (December 2025)

Posted on December 4, 2025

Health New England will review retrospective authorization requests in limited circumstances, as described below.

• When the member has been added retrospectively to HNE after services have been provided or during a course of continuing treatment; or
• The member has been referred or received same day services; or
• The service was urgent or emergent in nature; and/or
• Enrollment with HNE/eligibility and/or member benefit unable to be verified; or
• Non-emergent ambulance transportation.

There must be documentation on the request indicating the reason the service was requested retrospectively.

Categories: Provider Newsletter