Providers must obtain authorization from eviCore® healthcare for:
- Physical, occupational and speech therapy services (by therapists) and physical medicine services by chiropractors. For dates of service on or after Jan. 1, 2021, this includes physical medicine services by athletic trainers, for Blue Care Network commercial members only.
- Select radiation oncology services
Note: eviCore managed interventional pain management procedures for BCN commercial and BCN AdvantageSM members through Dec. 31, 2020. For dates of service on or after Jan. 1, 2021, these services are managed by TurningPoint Healthcare Solutions LLC; refer to BCN's Musculoskeletal Services page on this website for more information.
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*
- 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 authorization by eviCore healthcare (PDF) - List of procedure codes eviCore reviews
- Services reviewed by eviCore for Blue Cross and BCN (PDF) - How to handle different types of authorization requests
- Oncology: For CAR-T cell therapy, medical oncology and radiation oncology (PDF) - Includes information about utilization management programs
Refer to the documents below.
- eviCore Management Program Frequently Asked Questions (PDF)
- eviCore coding guidelines for radiation oncology (PDF)*
See also BCN's Outpatient PT, OT, ST page on this website.
*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're not responsible for its content.