Prior authorizations & referrals
We are waiving prior authorization for certain infant formulas through the medical benefit. See here for details.
During the COVID-19 public health emergency, some of our authorization guidelines may be superseded by the information on our COVID-19 FAQ.
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Mass General Brigham Health Plan providers: How to submit
Use our Provider portal to submit prior authorization requests.
Instructions for submitting authorizations on our Provider portal:
Prior authorization reference guide for limited network products
Our prior authorization processes are slightly different for providers who are contracted with Mass General Brigham Health Plan, but not participating in one or more of our limited network products.
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Other providers: How to submit
Providers who are not contracted directly with Mass General Brigham Health Plan can now submit medical authorization requests online through this authorization request form. This includes:
- UnitedHealthCare Options PPO providers
- MultiPlan PHCS network providers
- Out-of-network providers
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Services that require referrals or authorizations
- Log into the provider portal for member-specific information
- View a PDF of all services that require referrals, authorizations, or notifications
- View the Medicare Advantage prior authorization and notification guidelines
- View a PDF of durable medical equipment, medical supplies, oxygen related equipment, orthotics prosthetics and hearing aids that require prior authorization
How to submit authorizations to our partners
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Behavioral health: Optum
Provider Service for Mass General Brigham employee plans: 844-451-3520
Provider Service for all other plans: 844-451-3518
Visit the Optum Provider Express Portal for more information and to submit prior authorization requests.
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Medical specialty drugs: NovoLogix
Medical specialty drugs that require prior authorization are reviewed through NovoLogix.
Online
Submit your request through the NovoLogix online prior authorization tool for the fastest processing. You can access the NovoLogix online prior authorization tool through the Provider portal.
Fax/Phone
For all medical specialty drugs, you can use one of the Standard Prior Authorization forms and submit your request to NovoLogix via fax at 844-851-0882.
NovoLogix customer service: 844-345-2803
For more information, including Prior Authorization forms and Medical Specialty criteria, visit our Medical Specialty and Pharmacy Policy page.
- Pharmacy: CVS Caremark
Mass General Brigham Employee Plan Requests
Phone: 800-364-6331
Specialty Drug Requests (All Other Plans)
Phone: 866-814-5506
Fax: 866-249-6155
Non-Specialty Drug Requests
Commercial Plans
Phone: 800-294-5979
Fax: 888-836-0730
Health Connector Plans
Phone: 855-582-2022
Fax: 855-245-2134
My Care Family
Phone: 877-433-7643
Fax: 866-255-7569
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Pharmacy: CVS Caremark
CVS Caremark manages pharmacy benefits for Mass General Brigham Health Plans with prescription drug coverage. For the fastest service, please call the dedicated customer service line for your patients' plan or product.
Mass General Brigham Employee Plan Requests
800-364-6331Specialty Drug Requests (All Other Plans)
Phone: 866-814-5506
Fax: 866-249-6155Non-Specialty Drug Requests
Commercial Plans
Phone: 800-294-5979
Fax: 888-836-0730Health Connector Plans
Phone: 855-582-2022
Fax: 855-245-2134My Care Family
Phone: 877-433-7643
Fax: 866-255-7569 -
Sleep management: CareCentrix
Provider Service: 866-827-5861
Visit the CareCentrix portal for more information and to submit prior authorization requests.
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Molecular and genetic testing: EviCore
Molecular and Genetic Testing
Provider Service: 888-693-3211
Visit the dedicated Mass General Brigham Health Plan resource page on the EviCore website.
Use the eviCore Provider Portal to submit prior authorization requests
Please note: As of July 18, 2021, EviCore no longer processes prior authorization requests for high-tech radiology or cardiac imaging. To request approval for those services, use the authorization tool in our Provider portal.