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Utilization Management
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Continuity and Care CoordinationeviCoreHigh End Imaging - Cardiac studies and elective heart catheterizationHigh end imaging - radiation servicesHome HealthHospital admissions - Pre-certificationHospital Urgent/Observation AdmissionInappropriate Discharge and ReadmissionInpatient Acute Rehabilitation/Long Term Acute CareMedical NecessityMusculoskeletal proceduresNavihealth-Skilled Nursing Facility CareNorthwood DMENursing Facility Care/Skilled Nursing Facility CarePhysical, Speech and Occupational Therapy - OutpatientPre-certification Notification and Concurrent Review GuidePrior authorizationPrior Authorization for Non-affiliated ProvidersProvider Appeal and Grievance PolicySecond OpinionServices related to oral appliances - for treatment of obstructive sleep apneaSleep managementSterilization: Hysterectomy CoverageTechnology AssessmentUtilization management general informationUtilization management for behavior healthUtilization management for timeliness standards
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Family Health Center
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Claims Processing and Policies and Procedures
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Anatomical Modifier Requirement PolicyClaims Coding ResourceClaims Payment CalendarClean Claim and InterestCMS 1500 InstructionsCoordination of BenefitsCorrection Adjustment RequestData Security and ConfidentialityDrug Wastage PoliciesElectronic ClaimsElectronic File Submission ProcessLimitation of LiabilityModifier InformationNational Drug Code RequirementsOutput ReportsProvider Appeal and Grievance PolicyProvider Remittance Advice StatementReference Outside Laboratory Billing ProtocolReimbursement Recovery ProcessSubrogationTesting ProceduresTimely Filing for Claim SubmissionTrading Partner for Electronic DataTransaction TermsTransmissionUB 04 Instructions and Sample Claim FormUnlisted CodesWorkers Compensation
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Group & Direct Pay
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Pharmacy
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Utilization Management
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Medicare Advantage
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Product Overview D-SNP
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Utilization Management
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Authorization of Inpatient CareContinuity and Care CoordinationeviCoreHigh End Imaging - Cardiac imaging and elective heart catheterizationHigh End Imaging - Radiation ServicesHome HealthHome IV Drug TherapiesHospice ProtocolsHospital Inpatient Utilization ReviewHospital Urgent/Observation AdmissionInappropriate Discharge and ReadmissionInpatient Acute Rehabilitation/Long Term Acute CareMedical NecessityMusculoskeletal proceduresNavihealth-Skilled Nursing Facility CareNorthwood DMEPharmaceuticals - Specialty Medications (Magellan)Physical, Speech and Occupational Therapy - OutpatientPre-Certification Notification and Concurrent Review GuidePrior authorizationsProvider appeal and grievance policyRadiation Oncology ServicesSecond OpinionServices related to oral appliances - for treatment of obstructive sleep apneaSkilled Nursing Facility AdmissionSleep managementTechnology AssessmentUtilization management general informationUtilization Management for behavior healthUtilization Management for timeliness standards
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Product Overview D-SNP
High end imaging
Last Updated on February 19, 2026
High-end imaging
Security Health Plan requires prior authorization for all outpatient high-end imaging tests: MRI, CT (excluding SPECT) and PET scans. A complete list of CPT codes requiring prior authorization can be found below. Services performed without authorization may be denied for payment. You may not seek reimbursement from members for these services.
A prior authorization is required for all providers, facilities and ancillary providers for aforementioned high-end imaging procedures prior to performance, with administrative claim denial for non-compliance. The ordering provider maintains final decision authority of which high-end imaging test is performed. If an affiliated provider fails to prior notify, retro-notification will not be accepted.
The ordering provider or designee is responsible for obtaining a prior authorization number prior to scheduling high-end outpatient imaging procedures. It is the rendering provider’s responsibility to ensure prior authorization requirements are met before a member’s scheduled appointment. If prior authorization requirements are not met, claims could be denied.
Authorization is required for:
- MRI
- MRA
- CT
- CTA
- PET
- Nuclear cardiac
Request authorization
- Register online for an account
- Online – 24 hours a day, seven days a week at www.evicore.com/
To request an authorization, submit your request online, by phone or fax:
Call eviCore at 1-888-693-3211 and choose option 4 for physicians. Here, providers may request or schedule a live peer-to-peer conversation. Please have the case or authorization number on the denial/fax letter ready.
- Log in to www.evicore.com/
- Phone: 1-888-693-3211
- Fax an eviCore request form (available online) to 1-888-693-3210
Resources
View code list for high end imaging prior authorizations
eviCore FAQs
eviCore healthcare’s Clinical Guidelines and request forms are available at: www.evicore.com or click here to access guidelines specific to Security Health Plan. Please call the Client Provider Operations Department at1-800-646-0418 , option 4, if you have any questions or need more information.