Changes coming to eviCore authorizations Sept. 5

We're making changes to our eviCore prior authorization program based on your feedback. We believe these changes will serve you better while ensuring our members are getting high quality, cost-effective care.

Changes to high-tech radiology authorizations

Starting on Sept. 5, a subset of the high-tech radiology CPT codes will no longer be approved automatically when you enter an auth request for them in eviCore. They will now require authorization. This means:

  • Some requests may pend for additional information. Once the information is received a decision will be made within two business days. 
  • These codes will be subject to denials. You'll have the option to request peer-to-peer review for services to commercial and Medicaid members within 14 days from the date of denial.

The remainder of the high-tech radiology CPT codes will keep being approved automatically as you request them.

Find a new high-tech radiology CPT code list that indicates which codes need prior auth review and which codes remain on auto-approval at www.evicore.com/healthplan/priorityhealth.

Plan types affected

Authorization for these high-tech radiology services will be required for all Priority Health product lines, including commercial group and individual plans, Medicare and Medicaid.

What's not changing

You'll continue to request authorizations using our Auth Request tool, which will send you to either Clear CoverageSM or to eviCore Healthcare, depending on the codes you enter.

  • Musculoskeletal procedures will remain on auto approval until we've finalized an improved process.
  • Genetic testing remains on prior authorization.
  • Urgent authorizations should be handled by calling eviCore at 844.303.8456.

Enhancements to eviCore authorizations online

eviCore is making improvements to their online auth request experience based on feedback from you. These will soon include:

  • More real-time results as a result of your concerns about the number of cases pending without the ability to enter in relevant data.
  • Easier data entries with new features like a back button, duplicate option, and save/finish later choices.
  • Fewer "provider and member not found" messages.
  • Live training options, including on-site visits and webinars from eviCore. 
  • Less waiting, better specialty matching and more reliable access to eviCore clinicians for peer reviews.
  • Shorter hold times when calling; eviCore has hired more customer service and nursing staff.
  • Removal of delays or denials based on contrast rules.

See eviCore online training opportunities

Register for provider orientation webinars and view/print FAQs and quick reference guides in the Provider Center > Authorizations > Auth Request > eviCore training and help.