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EXC - PRV - EPA Outage - temp
If you receive an email error message stating “You have no associated provider sets”, we can help you; please email your Web Username and Individual NPI to CAPAdministrator@excellus.com to update the system. At this time, there may be up to a two hour delay after receiving your information for the system update. Thank you for your patience as we make improvements.
If you have any questions, please contact your Provider Relations representative.
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Authorizations
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:
- Prior Authorization Guidelines Code List - January 17, 2020Open a PDF
- Prior Authorization Guidelines Code List - January 1, 2020Open a PDF
- Durable Medical Equipment - January 17, 2020Open a PDF
- Durable Medical Equipment - January 1, 2020Open a PDF
- Sleep Management Program Update
- Medical Specialty Drug (For Commercial, Essential Plan, Exchange and Medicare)Open a PDF
- Medical Specialty Drug (For Medicaid and Child Health Plus)Open a PDF
- eviCore Codes Requiring Preauthorization - Master GridOpen a PDF
Behavioral Health Procedure Codes Requiring Preauthorization:
- Commercial Medicare & Child Health Plus Products - July 1, 2019Open a PDF
- Managed Medicaid & Health and Recovery Plan Products - July 1, 2019Open a PDF
New to Clear Coverage? Provider Resource GuideOpen a PDF (Login Required) | Admission Procedures Now AvailableOpen a PDF
