Advanced Imaging, Cardiology and Musculoskeletal support

We want our members to get the best care for the best cost. And we know you do, too. That’s why we partner with eviCore for prior authorization. eviCore uses evidence-based guidelines for their review process. We trust that our partnership with them supports our members and your work.

Does my patient need a prior authorization?

See if your patients require prior authorization by logging in to Benefit Tracker or call our customer service team toll-free at 877-605-3229. Contact eviCore for authorization at 844-303-8451 or visit eviCore.com to initiate a prior authorization.

eviCore provides prior authorization reviews for many different services

Most often, eviCore reviews advanced imaging for radiology and cardiology (CT and PET scans, MRIs, etc.)

 

CPT codes that require prior authorization

• Cardiology CPT codes that require prior-authorizations  - a list of cardiology CPT codes that require prior authorization
• Radiology CPT codes that require prior-authorizations  - a list of radiology CPT codes that require prior authorization
• Joint surgery CPT codes that require prior-authorizations - a list of joint survey CPT code that require prior authorization
• Pain management CPT codes that require prior-authorizations - a list of pain management CPT code that require prior authorization
• Spine surgery CPT codes that require prior-authorizations - a list of pain management CPT code that require prior authorization

 

What to do if a prior authorization isn’t approved

Read the Guide to handling denied prior authorizations from eviCore for more help.

 

Tips to help your prior authorization go smoothly

 Here are several additional resources to help make sure your prior authorization goes smoothly

• Customized training for your staff - ask your Med PR representative to set up a customized training program for your staff with eviCore’s training team.
• Request a consult with a peer reviewer - Your request will be looked at to make sure it is available for this kind of review. To submit this request, please complete the online form. You will then receive a confirmation email, and eviCore’s Physician Services Unit will contact your office to schedule an appointment time.
• eviCore’s Clinical Worksheets - review eviCore's worksheets to help make you are submitting information that meets their guidelines.