Prior authorizations & referrals
Learn how to submit prior authorization requests to Mass General Brigham Health Plan and our partners.
Streamlining your experience
Get prior authorization approvals instantly with the easy-to-use tool in our provider portal. Not registered for our portal yet? No problem — that's easy too. Learn more about our digital tools.
Save time on outpatient authorization requests
- For outpatient services that meet criteria, you will receive approvals in seconds
- Request authorization and enter medical necessity information in one screen
- Get approvals 24-hours a day, 7 days a week
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. 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
How to submit authorizations to our partners
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.
Resources for your practice
- Quick reference factsheet
- Authorization tip sheet
- Watch our authorization process training video
- Answers to top provider questions
From our blog
5 tips for a great experience
Get the most out of our online authorization tools with five simple tips. Read more
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and Mass General Brigham Health Insurance Company