Providers must obtain authorization from eviCore healthcare for:
- Select interventional pain management and radiation therapy services
- Physical, occupational and speech therapy services (by therapists) and physical medicine services by chiropractors. Starting May 27, 2019, this includes both initial and follow-up visits.
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 to eviCore in one of these ways:
- By clicking the Authorizations and Referrals button for the member on the web-DENIS Eligibility/Coverage screen
- Through the eviCore healthcare provider portal at www.evicore.com
*Blue Care Network does not control this website or endorse its general content.
- 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:
See also BCN's Outpatient PT, OT, ST page on this website.