eviCore-Managed Procedures

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:

Additional information

Refer to the documents below.

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

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