Advanced Imaging and musculoskeletal utilization management programs
Working with eviCore
We want our members to get the best care for the best cost. And we know you do, too. That’s why we partner with eviCore for prior authorization. eviCore uses evidence-based guidelines for their review process. We trust that our partnership with them supports our members and your work.
See if your patients require prior authorization through eviCore
Log in to Benefit Tracker or call our customer service team toll-free at 800-592-8283.
eviCore provides prior authorization reviews for many different services
Most often, eviCore reviews advanced imaging for radiology and cardiology (CT and PET scans, MRIs, etc.) and musculoskeletal services (chiropractic, acupuncture, massage, physical and occupational therapy, etc.). They may review different services for different plans. Please see the following list of CPT codes that require prior authorization:
- Cardiology
- Joint surgery
- Radiology
- Pain management
- Spine surgery
- Therapy (including Alternative Care)
- High-Tech Radiology SOC policy effective for certain groups
Benefits of working with eviCore
Overview of how Moda works with eviCore
Here’s how eviCore’s prior authorization process works
What to do if a prior authorization isn’t approved
Guide to handling denied prior authorizations
Treatment for autism spectrum disorder and neurodevelopmental conditions
If you have questions about intensive outpatient rehabilitation authorizations for the treatment of autism spectrum disorder or neurodevelopmental conditions, please contact our Healthcare Services team at 800-592-8283.
Tips to help your prior authorization go smoothly
- Ask your Moda Health Med PR representative to set up a customized training for your staff and eviCore’s training team
- Request a consult with a peer reviewer. Your request will be looked at to make sure it is available for this kind of review. To submit this request, please complete the online form. You will then receive a confirmation email, and eviCore’s Physician Services Unit will contact your office to schedule an appointment time.
- Consider using eviCore’s Clinical Worksheets to make sure you are submitting information that meets their guidelines.
Questions?
If you can't find an answer, please feel free to contact our Customer Service Customer Service Customer Service
Questions?
If you can't find an answer, please feel free to contact our Customer Service
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