Prior authorization contact information
Please have your provider contact the vendors below to request prior authorization when needed.
eviCore contact information
Autologous cultured chondrocytes; back, hip and knee surgery; infused bone graft; spine and joint surgery and pain management.
www.evicore.com
Phone: (888) 444-6185
Fax an eviCore request form (available online) to (800) 540-2406
High-end imaging, cardiac imaging and heart catheterization
www.evicore.com
Phone: (888) 693-3211
Fax an eviCore request form (available online) to (888) 693-3210
eviti contact information
Oncology Treatment (Chemotherapy and Radiation Oncology)
www.connect.eviti.comPhone: (888) 482-8057
Prime Therapeutics Management contact information
Security Health Plan of Wisconsin, Inc., collaborates with Prime Therapeutics Management to manage prior authorization (PA) and/or post-service claim edits (PSCE) for select specialty pharmacy medications.
Phone: (800) 424-8243
Fax: (888) 656-6671
Northwood contact information
For durable medical equipment, prosthetic-orthotics and amino acid formula.
Your provider will work with Northwood to ensure that authorizations are in place for products and services you receive.
Phone: (866) 532-1344
Fax: (866) 483-9988