Providers must obtain authorization from eviCore^® healthcare for:

• 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. 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 therapy services
• Select interventional pain management services – For dates of service from Sept. 1, 2016, through Dec. 31, 2020. You can submit retrospective authorization requests to eviCore through April 30, 2021.
  
  For dates of service on or after Jan. 1, 2021, submit authorization requests for pain management procedures to TurningPoint Healthcare Solutions, LLC. See the BCN Musculoskeletal Services page 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
• Pain management authorizations: Quick reference guide (PDF) - Overview of pain management authorization requirements
• Services reviewed by eviCore for Blue Cross and BCN (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:

• eviCore Management Program Frequently Asked Questions (PDF)

See also BCN's Outpatient PT, OT, ST page on this website.

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