Providers must obtain authorization from eviCore healthcare for select interventional pain management and radiation therapy services. eviCore healthcare also manages physical, occupational and speech therapy services (by therapists) and physical medicine services by chiropractors.
Note: For select cardiology and radiology procedures, eviCore healthcare manages authorizations for dates of service prior to Oct. 1, 2018, including postservice requests.
All BCN-participating freestanding diagnostic facilities, outpatient hospital settings, ambulatory surgery centers and physician offices that provide these services are required to submit authorization requests to eviCore healthcare.
When procedures reviewed by eviCore healthcare are performed in an observation, emergency or inpatient care setting, they do not require authorization.
Requests for authorization must be submitted by visiting evicore.com or by calling 1-855-774-1317, preferably prior to services being rendered.
Refer to the resources below for more information:
- Authorizations Quick Reference Guide (PDF) - How to submit a request to eviCore
- Procedures that require clinical review by eviCore healthcare (PDF) - List of procedure codes eviCore reviews
- Pain management authorizations: Quick reference guide (PDF) - Overview of pain management authorization requirements
- Guidelines for services reviewed by eviCore healthcare for Medicare Plus BlueSM PPO and Blue Care Network (PDF) - How to handle different types of authorization requests
Frequently asked questions
Refer to the FAQ document below for answers to questions commonly asked about the eviCore healthcare review process:
In the FAQ, you'll find the answers to such questions as:
- What information is required when submitting a request for clinical review?
- Can the servicing provider request clinical review?
- Do services provided in a hospital inpatient setting or in an emergency room setting require clinical review?
... and many more!