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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

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:

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Behavioral Health Procedure Codes Requiring Preauthorization: