EXC - PRV - EPA Outage - temp
Expand the appropriate service type category to locate our CareAdvance Provider navigation guide, WebEx and tip sheet.
Please click here to access FAQs Opens a PDF.
If you receive an error message stating "You have no associated provider sets", we can help you;
please email your Web Username and Individual or Group NPI to CAPAdministrator@excellus.com to update the system.
If you have any questions, please contact your Provider Relations Representative.
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Search for Required Medical Services-Request Authorization Page Tab Content
GLO-PRV-Search Authorization Page-Row 1 Content
The medical services including provider administered drugs below require prior review by the plan to determine clinical medical necessity.
Authorization - Preauthorization - Basic Web Content
The services below require prior review by the Plan to determine clinical medical necessity for all places of service. Not all services are covered by all medical plans. There may be services that require preauthorization or notification that do not require clinical review. Final determination of coverage is subject to the member’s benefits and eligibility on the date of service.
- All eviCore services can also be validated for prior authorization requirements via eviCore.com
Who Can Request: For HMO/POS plans, the member’s PCP or specialist with a valid referral. Other members, the member's PCP or treating provider.
Medical Health Procedure Codes Requiring Prior Authorization:
- Medical Prior Authorization Code List - June 1, 2020Open a PDF
- Medical Prior Authorization Code List - April 6, 2020Open a PDF
- Durable Medical Equipment - June 1, 2020Open a PDF
- Durable Medical Equipment - January 17, 2020Open a PDF
- Medical Specialty Drug (For Commercial, Exchange and Medicare)Open a PDF
- Medical Specialty Drug (For Medicaid, Safety Net, and Essential Plan)Open a PDF
- eviCore Codes Requiring Preauthorization - Master GridOpen a PDF
Behavioral Health Procedure Codes Requiring Preauthorization: