Prior authorizations & referrals

Use our Provider portal to submit prior authorization requests.

Instructions for submitting authorizations on our Provider portal:

• Home Health Care
• Inpatient
• Outpatient
• Referrals
• Fax Coversheet
  
  

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. This PDF will help direct you to submit requests to the appropriate location.

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

• 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

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.

Medical specialty and specialty drugs that require prior authorization are reviewed through Specialty Fusion. 

Online

Submit your request through the Specialty Fusion online prior authorization tool for the fastest processing. You can access this online prior authorization tool through the Provider portal.

Fax/Phone

For all specialty drugs, you can use one of the Standard Prior Authorization forms and submit your request to Specialty Fusion via fax at 855-540-3693.

Specialty Fusion customer service: 877-519-1908.

For more information, including Prior Authorization forms and Medical Specialty criteria, visit our Medical Specialty and Pharmacy Policy page.

 

Optum Rx manages pharmacy benefits for Mass General Brigham Health Plans with prescription drug coverage.

Phone: 800-711-4555
Fax: 844-403-1029

Provider Service: 866-827-5861

Visit the CareCentrix portal for more information and to submit prior authorization requests.

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.