Welcome to the Optum Network!

Massachusetts Provider Resources

Optum Network Manual

• Network Manual
• Mass General Brigham Health Plan Provider Manual Addendum (Rev. 06/2022)

Performance Specifications

• Medicaid

Clinical Criteria

• Standard Clinical Criteria

Best Practice Guidelines

• BP Guidelines

Coordination of Care (COC)

• COC Flyer
• COC Checklist

Mandates

MA Commercial Business Emergency Department Boarding Prevention Special Services Facility Authorization Process

Child Adolescent Needs and Strengths (CANS) Assessment Medicaid Requirement

Supplemental Clinical Criteria: Massachusetts Commercial (BHCA)

Clinical Area of Expertise Update:  PANDAS-PANS

Prior Authorization Forms

• Level of Care Request
  • Fax: 844-330-4967 or Email: UTP-PHL@optum.com
• Repetitive Transcranial Magnetic Stimulation (TMS) Request
  • Fax: 844-330-4967 or Email: UTP-PHL@optum.com
• Psychological and Neuropsychological Assessment Supplemental Form
  • Fax: 888-216-4795

Additional information and forms are available, including psych/neuropsych testing guidelines, credentialing plans, and Disability Solutions Manual, on the Provider Express Guidelines/Policies & Manuals and Optum Forms pages.

General Information

Provider Training Materials

Designated Community Behavioral Health Centers

Mass General Brigham Health Plan

Massachusetts Medicaid

Harvard Pilgrim Health Plan

UnitedHealthcare