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</li> </ul> </nav></div> </div> <div class="mob_menu"> </div> <div class="des_srch"> <div id="hs_cos_wrapper_st_srch" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"> <div class="hs-search-field"> <div class="hs-search-field__bar"> <div class="block-title">Search</div> <form action="/hs-search-results"> <div class="frm_item"> <input type="text" class="hs-search-field__input" name="term" autocomplete="off" aria-label="Search" placeholder="Search"> </div> <input type="hidden" name="type" value="SITE_PAGE"> <input type="hidden" name="type" value="BLOG_POST"> <input type="hidden" name="type" value="LISTING_PAGE"> <div class="frm_btn"> <button aria-label="Search"></button> </div> </form> </div> <ul class="hs-search-field__suggestions"></ul> </div></div> </div> </div> </div> </header> </div></div> <main id="main-content" class="body-container-wrapper home-page"> <div class="container-fluid home-row1"> <div class="row-fluid-wrapper"> <div class="row-fluid"> <div class="span12 widget-span widget-type-cell " style="" data-widget-type="cell" data-x="0" data-w="12"> </div> </div> </div> </div> <div class="container-fluid home-row2"> <div class="row-fluid-wrapper"> <div class="row-fluid"> <div class="span12 widget-span widget-type-cell " style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-1 dnd-section row2-row-0-background-layers row2-row-0-background-color"> <div class="row-fluid "> <div class="span12 widget-span widget-type-cell dnd-column" style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-2 dnd-row"> <div class="row-fluid "> <div class="span12 widget-span widget-type-custom_widget dnd-module" style="" data-widget-type="custom_widget" data-x="0" data-w="12"> <div id="hs_cos_wrapper_module_17370612900375" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module widget-type-rich_text" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"><span id="hs_cos_wrapper_module_17370612900375_" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_rich_text" style="" data-hs-cos-general-type="widget" data-hs-cos-type="rich_text"><h1>Prior authorizations & referrals</h1> <h3>Learn how to submit prior authorization requests to Mass General Brigham Health Plan and our partners. </h3></span></div> </div> </div> </div> </div> </div> </div> <div class="row-fluid-wrapper row-depth-1 row-number-3 dnd-section"> <div class="row-fluid "> <div class="span12 widget-span widget-type-cell cell_16751761035842-hidden dnd-column" style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-4 dnd-row"> <div class="row-fluid "> <div class="span12 widget-span widget-type-custom_widget dnd-module" style="" data-widget-type="custom_widget" data-x="0" data-w="12"> <div id="hs_cos_wrapper_widget_1675176103314" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module widget-type-rich_text" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"><span id="hs_cos_wrapper_widget_1675176103314_" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_rich_text" style="" data-hs-cos-general-type="widget" data-hs-cos-type="rich_text"><h2>Streamlining your experience</h2> <p>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.<span> </span><a href="/providers/portal" rel="noopener">Learn more about our digital tools</a>. </p> <h3>Save time on outpatient authorization requests</h3> <ul> <li>For outpatient services that meet criteria, you will receive approvals in seconds</li> <li>Request authorization and enter medical necessity information in one screen</li> <li>Get approvals 24-hours a day, 7 days a week</li> </ul></span></div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="container-fluid home-row3"> <div class="row-fluid-wrapper"> <div class="row-fluid"> <div class="span12 widget-span widget-type-cell " style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-1 dnd-section"> <div class="row-fluid "> <div class="span12 widget-span widget-type-cell dnd-column" style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-2 dnd-row"> <div class="row-fluid "> <div class="span12 widget-span widget-type-custom_widget dnd-module" style="" data-widget-type="custom_widget" data-x="0" data-w="12"> <div id="hs_cos_wrapper_widget_1670351890826" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"><div class="accordion widget_1670351890826" id=""> <ul> <li class="accordion-item"> <a class="accordion-item__title" href="javascript:void(0)"> Mass General Brigham Health Plan providers: How to submit </a> <div class="accordion-content"> <div class="accordion-item__body"> <p>Use our<span> </span><a href="https://provider.massgeneralbrighamhealthplan.org" rel="noopener" target="_blank">Provider portal</a> to submit prior authorization requests.</p> <p>Instructions for submitting authorizations on our Provider portal:</p> <ul> <li><a href="https://resources.massgeneralbrighamhealthplan.org/utilizationmgmt/UserGuideHomeHealth.pdf" rel="noopener noreferrer" target="_blank">Home Health Care</a></li> <li><a href="https://resources.massgeneralbrighamhealthplan.org/utilizationmgmt/UserGuideInpatient.pdf" rel="noopener noreferrer" target="_blank">Inpatient</a></li> <li><a href="https://resources.massgeneralbrighamhealthplan.org/utilizationmgmt/UserGuideOutpatient.pdf" rel="noopener noreferrer" target="_blank">Outpatient</a></li> <li><a href="https://resources.massgeneralbrighamhealthplan.org/utilizationmgmt/UserGuideOnlineReferrals.pdf" rel="noopener noreferrer" target="_blank">Referrals</a></li> <li><a href="https://resources.massgeneralbrighamhealthplan.org/utilizationmgmt/Faxcoversheet.pdf" rel="noopener noreferrer" target="_blank">Fax Coversheet</a><br><br></li> </ul> <p><strong>Prior authorization reference guide for limited network products</strong></p> <p><span>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. <a href="https://resources.massgeneralbrighamhealthplan.org/providers/PA%20guide%20for%20limited%20network%20products.pdf" target="_blank" rel="noopener">This PDF will help direct you to submit requests to the appropriate location.</a></span></p> </div> </div> </li> <li class="accordion-item"> <a class="accordion-item__title" href="javascript:void(0)"> Other providers: How to submit </a> <div class="accordion-content"> <div class="accordion-item__body"> <p>Providers who are not contracted directly with Mass General Brigham Health Plan can now submit medical authorization requests online through this<span> </span><a href="https://provider.massgeneralbrighamhealthplan.org/PublicSite/Home" rel="noopener noreferrer" target="_blank">authorization request form</a>. This includes:</p> <ul> <li>UnitedHealthCare Options PPO providers</li> <li>MultiPlan PHCS network providers</li> <li>Out-of-network providers</li> </ul> </div> </div> </li> <li class="accordion-item"> <a class="accordion-item__title" href="javascript:void(0)"> Services that require referrals or authorizations </a> <div class="accordion-content"> <div class="accordion-item__body"> <ul> <li><a href="https://provider.massgeneralbrighamhealthplan.org" rel="noopener" target="_blank">Log into the provider portal for member-specific information</a></li> <li><a href="https://resources.massgeneralbrighamhealthplan.org/utilizationmgmt/PAGuide.pdf" rel="noopener noreferrer" target="_blank">View a PDF of all services that require referrals, authorizations, or notifications</a></li> <li><a href="https://resources.massgeneralbrighamhealthplan.org/utilizationmgmt/PA%20Grid%20MA.pdf" target="_blank" rel="noopener noreferrer">View the Medicare Advantage prior authorization and notification guidelines</a></li> <li><a href="http://resources.massgeneralbrighamhealthplan.org/utilizationmgmt/PA_DME.pdf" rel="noopener noreferrer" target="_blank">View a PDF of durable medical equipment, medical supplies, oxygen related equipment, orthotics prosthetics and hearing aids that require prior authorization</a></li> </ul> </div> </div> </li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="container-fluid home-row4"> <div class="row-fluid-wrapper"> <div class="row-fluid"> <div class="span12 widget-span widget-type-cell " style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-1 dnd-section"> <div class="row-fluid "> <div class="span12 widget-span widget-type-cell dnd-column" style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-2 dnd-row"> <div class="row-fluid "> <div class="span12 widget-span widget-type-custom_widget dnd-module" style="" data-widget-type="custom_widget" data-x="0" data-w="12"> <div id="hs_cos_wrapper_widget_1670351977662" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module widget-type-header" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"> <span id="hs_cos_wrapper_widget_1670351977662_" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_header" style="" data-hs-cos-general-type="widget" data-hs-cos-type="header"><h2>How to submit authorizations to our partners</h2></span></div> </div> </div> </div> <div class="row-fluid-wrapper row-depth-1 row-number-3 dnd-row"> <div class="row-fluid "> <div class="span12 widget-span widget-type-custom_widget dnd-module" style="" data-widget-type="custom_widget" data-x="0" data-w="12"> <div id="hs_cos_wrapper_widget_1670351986798" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"><div class="accordion widget_1670351986798" id=""> <ul> <li class="accordion-item"> <a class="accordion-item__title" href="javascript:void(0)"> Behavioral health: Optum </a> <div class="accordion-content"> <div class="accordion-item__body"> <p>Provider Service for Mass General Brigham employee plans: <a href="tel:844-451-3520">844-451-3520</a></p> <p>Provider Service for all other plans: <a href="tel:844-451-3518">844-451-3518</a></p> <p>Visit the <a href="https://www.providerexpress.com/content/ope-provexpr/us/en.html" rel="noopener noreferrer" target="_blank">Optum Provider Express Portal</a> for more information and to submit prior authorization requests.</p> </div> </div> </li> <li class="accordion-item"> <a class="accordion-item__title" href="javascript:void(0)"> Specialty drugs: Specialty Fusion </a> <div class="accordion-content"> <div class="accordion-item__body"> <p>Medical specialty and specialty drugs that require prior authorization are reviewed through Specialty Fusion. </p> <h3>Online</h3> <p>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 <a href="http://provider.massgeneralbrighamhealthplan.org" rel="noopener" target="_blank">Provider portal</a>.</p> <h3>Fax/Phone</h3> <p>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.</p> <p>Specialty Fusion customer service: 877-519-1908.</p> <p>For more information, including Prior Authorization forms and Medical Specialty criteria, <a href="https://www.allwayshealthpartners.org/providers/pharmacy-guidelines">visit our Medical Specialty and Pharmacy Policy page</a>.</p> <p> </p> </div> </div> </li> <li class="accordion-item"> <a class="accordion-item__title" href="javascript:void(0)"> Non-Specialty and Non-Formulary: Optum Rx </a> <div class="accordion-content"> <div class="accordion-item__body"> <p>Optum Rx manages pharmacy benefits for Mass General Brigham Health Plans with prescription drug coverage.</p> <p>Phone: 800-711-4555<br>Fax: 844-403-1029</p> </div> </div> </li> <li class="accordion-item"> <a class="accordion-item__title" href="javascript:void(0)"> Sleep management: CareCentrix </a> <div class="accordion-content"> <div class="accordion-item__body"> <p>Provider Service: <a href="tel:866-827-5861">866-827-5861</a></p> <p>Visit the <a href="https://www.carecentrixportal.com/ProviderPortal/homePage.do" rel="noopener noreferrer">CareCentrix portal</a> for more information and to submit prior authorization requests.</p> </div> </div> </li> <li class="accordion-item"> <a class="accordion-item__title" href="javascript:void(0)"> Molecular and genetic testing: EviCore </a> <div class="accordion-content"> <div class="accordion-item__body"> <p>Molecular and Genetic Testing</p> <p>Provider Service: <a href="tel:888-693-3211">888-693-3211</a></p> <p><span style="text-decoration: underline;"><a href="https://secure-web.cisco.com/1UnALmd6JMxLNfCl9hl1KKXuhhEvswDjlYuDY5n7JVqluKHVR3AH3Bx7I1IkBZ9nuSGI-3QY_xeb0fdMM5As5YNfuuuLB15sGLy6sOKVkMgCrGzLFe2I7poOC1V-Z4zCpetCRtAia4zdhjbx2lmlvZYJSCIZ54jtlTIa3GNHiQ7buQBnBHM4Ts7c7k28rq6UwP2VoRf7qdJMmPQVV43aTMqbN8E5SvUVeqNVx2Cfk9fmoEZjymMYa8rT2KReDT4kQaNm9B1reoInnw36bP5lMBLG6EAN8mnqjZDnNBNbhi-H1lQMVEnvFrAxlWrL5HBf3/https%3A%2F%2Fwww.evicore.com%2Fprovider%2Fclinical-guidelines-details%3Fsolution%3Dlaboratory%2520management%26hPlan%3DMass%2520General%2520Brigham%2520Health%2520Plan" rel="noopener noreferrer" target="_blank">Visit the dedicated Mass General Brigham Health Plan resource page on the EviCore website.</a></span></p> <p>Use the <a href="https://www.evicore.com/pages/providerlogin.aspx" rel="noopener noreferrer" target="_blank"><span style="text-decoration: underline;">eviCore Provider Portal</span></a> to submit prior authorization requests</p> <p>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<span> </span><a href="http://provider.massgeneralbrighamhealthplan.org" rel="noopener" target="_blank">Provider portal</a>. </p> </div> </div> </li> </ul> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="container-fluid home-row5"> <div class="row-fluid-wrapper"> <div class="row-fluid"> <div class="span12 widget-span widget-type-cell " style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-1 dnd-section"> <div class="row-fluid "> <div class="span12 widget-span widget-type-cell dnd-column" style="" data-widget-type="cell" data-x="0" data-w="12"> <div class="row-fluid-wrapper row-depth-1 row-number-2 dnd-row"> <div class="row-fluid "> <div class="span12 widget-span widget-type-custom_widget dnd-module" style="" data-widget-type="custom_widget" data-x="0" data-w="12"> <div id="hs_cos_wrapper_widget_1675176130982" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_module widget-type-rich_text" style="" data-hs-cos-general-type="widget" data-hs-cos-type="module"><span id="hs_cos_wrapper_widget_1675176130982_" class="hs_cos_wrapper hs_cos_wrapper_widget hs_cos_wrapper_type_rich_text" style="" data-hs-cos-general-type="widget" data-hs-cos-type="rich_text"><h3>Resources for your practice</h3> <ul> <li><a href="https://resources.massgeneralbrighamhealthplan.org/providers/DOC_Interqual-Factsheet.pdf" rel="noopener" target="_blank">Quick reference factsheet</a></li> <li><a href="https://5977230.fs1.hubspotusercontent-na1.net/hubfs/5977230/Auth%20tip%20sheet.pdf" rel="noopener" target="_blank">Authorization tip sheet</a></li> <li><a href="https://youtu.be/mLYhUhbg9Ao" rel="noopener" target="_blank">Watch our authorization process training video</a><span></span></li> <li><a href="https://resources.massgeneralbrighamhealthplan.org/providers/DOC_Authorization%20process%20FAQ.pdf" rel="noopener" target="_blank">Answers to top provider questions</a></li> </ul> <h4>From our blog</h4> <p><span style="font-weight: bold;">5 tips for a great experience</span><br><span>Get the most out of our online authorization tools with five simple tips. <a href="https://blog.allwayshealthpartners.org/five-tips-to-ensure-providers-success-with-new-authorization-process-for-high-tech-cardiac-imaging" rel="noopener" target="_blank">Read more</a></span></p></span></div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="container-fluid home-row6"> <div class="row-fluid-wrapper"> <div class="row-fluid"> <div class="span12 widget-span widget-type-cell " style="" data-widget-type="cell" data-x="0" data-w="12"> </div> </div> </div> </div> <div class="container-fluid home-row7"> <div class="row-fluid-wrapper"> <div class="row-fluid"> <div class="span12 widget-span widget-type-cell " style="" data-widget-type="cell" data-x="0" data-w="12"> </div> </div> </div> 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