Welcome to Mass General Brigham Health Plan

Authorization Submission Form

Providers who are outside of Mass General Brigham Health Plan provider network can now submit medical authorization requests online. This form is intended for:

• UnitedHealthCare Options PPO providers
• MultiPlan PHCS network providers
• Providers who are non-contracted with Mass General Brigham Health Plan

This form is NOT intended for:

• Mass General Brigham Health Plan network providers (submit your request directly through the Mass General Brigham Health Plan Provider Portal).
• Services managed through a vendor partner:
• Optum (Behavioral Health)
• NovoLogix (Medical Specialty Drugs)
• CareCentrix (Sleep Studies)
• eviCore (Molecular and genetic testing, radiation therapy)