Providers must obtain authorization from eviCore^® healthcare for:

• Outpatient physical, occupational and speech therapy services (by therapists) for BCN commercial and BCN Advantage members^SM when delivered by independent physical therapists, outpatient therapy providers, physician practices and hospital-based outpatient therapy services
• Physical medicine services by chiropractors and by athletic trainers for BCN commercial members only
• Select radiation oncology services for BCN commercial and BCN Advantage members

All BCN-participating freestanding diagnostic facilities, outpatient hospital settings, ambulatory surgery centers and physician offices that provide these services are required to submit prior 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 prior authorization must be submitted to eviCore:

• By accessing the eviCore provider portal through Availity^®:
1. Log in to our provider portal (availity.com*).
2. Click Payer Spaces on the menu bar and then click the BCBSM and BCN logo.
3. Click the eviCore Provider Portal tile on the Applications tab.
• Through the eviCore 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
• Procedure codes 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

Additional information

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.