Request through eviCore Healthcare

For Implantable Cardiac Devices, Radiology/Imaging, Radiation Therapy or Musculoskeletal Services (large joint replacement, pain management and spine services), request authorization online with eviCore healthcare, or call 1-866-889-8056.

Accessing eviCore healthcare Online

If you experience difficulty connecting from our website to eviCore healthcare, please call our Web Security Help Desk at 1-800-278-1247. For Questions about using the eviCore healthcare website, please call eviCore healthcare directly at 1-800-918-8924 ext 10036.

Par Providers: All access to the eviCore portal requires sign-ons to be set up under a participating provider or directly linked to a participating provider. If a provider leaves network, or is no longer participating with the health plan, sign-ons must be updated to the current in-office participating provider. Additional authorizations for additional doctors in your group can be created after linking to eviCore and entering the group's tax ID number.

Excellus providers can now access Excellus membership requests directly from the eviCore website when they register with eviCore healthcare www.eviCore.com.

Referring Providers: Site Selection is not required for all preauthorized services. If it is required, you will be asked to provide this information during the authorization process on the eviCore web portal. services being requested for the inpatient setting will require additional data related to the facility during the creation process.

Radiology Urgent / Emergent Requests

This Urgent/Emergent policy only applies to Excellus membership that requires prior authorization for high end radiology and Cardiac Imaging codes via eviCore

Urgent Emergent Studies
We do not require preauthorization for Radiology  & Cardiac Imaging studies when a patient presents in an emergency department, Inpatient Setting or 23 observation level of care at the hospital. 

When,  in the ordering physician's judgment, the patient's condition is urgent/emergent and directly ordering the study in an alternate location is the most appropriate course of action. Preauthorization is required through eviCore healthcare.  Reviews will be completed with 3 hours when documented as "urgent/emergent" in nature. These requests can be made via phone, fax or web based www.eviCore.com.

Appeals

Appeals can be initiated by a member or the provider if there is an ongoing disagreement with the decision. Appeals for the preauthorization can also be expedited. Both pre- and post-service appeals must be submitted to the Health Plan. To appeal a denied authorization or claim, please contact us.

Medicare appeals for preauthorization denials are to be submitted through the healthplan, they are not initiated at eviCore. Members may begin the appeal process by contacting the phone number on the back of their membership card. Providers may contact our Provider Service department to initiate an appeal.

Commercial appeals for preauthorization denials are to be submitted directly to us. Providers may contact our Provider Service department to initiate an appeal. Claims appeals are conducted after a claim has been denied on the provider remittance you receive from the Health Plan. To appeal a denied claim, please contact us.

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