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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.
GLO-PRV-Authorization-Clear Coverage-Hide Clear Coverage app and remove links
GLO-PRV-Authorization-Clear Coverage-Hide Clear Coverage app and remove links
Page Title for page template
Request Authorization
Search for Required Medical Services-Request Authorization Page Tab Content
Request Authorization Row 1 Content
Nested Applications
Request Authorization Accordion (new)
Safety Net:
Medicaid, Child Health Plus, Essential Plan
Safety Net:
Medicaid, Child Health Plus, Essential Plan
Online with eviCore healthcare
or call 1-866-889-8056
Call: 1-800-363-4658
Once the preauthorization has been obtained, call Behavioral Health Utilization for the clinical review: 1-800-277-2138
Safety Net:
Medicaid, Child Health Plus, Essential Plan
Call: 1-844-694-6411, or Fax: 1-844-6989
Call: 1-844-694-6411, or Fax: 1-844-620-7013
Concurrent review can be faxed to: 1-855-742-0126
- SafetyNet Fax Form for Inpatient Preauthorization RequestsOpen a PDF (Use Inpatient form for Observation Level of Service)
- SafetyNet Fax Form for Outpatient Preauthorization RequestsOpen a PDF
Online with Clear Coverage
For Medical Specialty Drug Unit, call: 1-800-306-0151, or fax: 1-800-306-0188.
Medicaid, Child Health Plus, Essential Plan
Online with CareAdvance Provider
or call 1-844-694-6411 or fax: 1-855-346-4418.
Online through CoverMyMeds ePA Portal
Fax: Prior Authorization Fax Request Forms
Eform: Send Request via Secure Eform (sends to our FAX server)
Or, call the number on the Member's ID Card
Request Authorization Right Side Col Content 1
Get Your Facets Provider ID
You'll need your Facets ID to use Clear Coverage or do Pre-Service Reviews at Other Blue Plans.
Request Authorization Right Side Col Content 2
Request Authorization Right Side Col Content 3
eviCore Healthcare Information
Get help with urgent/emergency requests, appeals process and help acessing eviCore online.
Learn more
Request Authorization - Modal for Facets ID
Modal for Get Your Facets Provider ID
Get Your Facets Provider ID
To recieve your Facets Provider ID you can either
- Call: 1-800-363-4658 or
- You can Email our Provider Help Desk
Behavioral Health Auth Forms Modal
Modal for Behavioral Health Fax and Request Forms
Behavioral Health Fax and Request Forms
- SafetyNet Fax Form for Inpatient Preauthorization RequestsOpen a PDF
- SafetyNet Fax Form for Outpatient Preauthorization RequestsOpen a PDF
- NeuroPsychological Testing Authorization Request FormOpen a PDF
Please use this form for Medicaid Managed Care and HARP (Blue Option Plus & Premier Option Plus) lines of business only - Outpatient Treatment Authorization Request FormOpen a PDF
- Adult Behavioral Health Home and Community Based Services (BH HCBS): Prior and/or Continuing Authorization Request FormOpen a PDF
Please include a completed HCBS Authorization Checklist along with the HCBS Prior and/or Continuing Authorization request form - HCBS Auth ChecklistOpen a PDF
GLO-PRV-Request Authorization-Clear Coverage Attestation Script
Script for showNoticeAttestation Function
