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Provider Manual

Musculoskeletal (Joint Surgery, Spine Surgery, Interventional Pain Management) and Therapies (Occupational Therapy, Physical Therapy, Speech Therapy)

Last Updated on April 23, 2019

Security Health Plan members in the above plans will require prior authorization from eviCore healthcare for dates of service beginning May 1, 2019. Services performed without prior authorization may be denied for payment, and you may not seek reimbursement from members.

Therapy and interventional pain management services performed in conjunction with an inpatient stay, 23-hour observation or emergency room visit are not subject to prior authorization requirements.

Authorization is required for:

  • Joint Surgeries
  • Spine Surgeries
  • Interventional Pain Management
  • Occupation Therapy
  • Physical Therapy
  • Speech Therapy

Request Authorization

To request a prior authorization:

For urgent requests:

If services are required in less than 48 hours due to the severity of the clinical presentation, please call eviCore’s toll-free number or you can initiate a case via the eviCore web portal for expedited prior authorization review. Be sure to tell the eviCore representative that the prior authorization request is for an urgent clinical presentation. If initiating the urgent request via the web you will have to upload clinical documentation with the case initiation.To request an authorization, submit your request online, by phone or fax:

Resources

View code list for the following prior authorizations:

eviCore  Musculoskeletal program FAQ
eviCore therapy program FAQ

eviCore healthcare’s Clinical Guidelines and request forms are available at: www.evicore.com.    Please call the Client Provider Operations department at 1-800-646-0418, option 4, if you have any questions or need more information.