Get Evicore Authorization Form 2019-2025

If the request from your health care provider does not meet evidence-based guidelines, you will receive a letter from eviCore letting you know why the request was not approved. The letter will include a reference to the clinical guidelines in question, which are transparent and available here for your review.

eviCore healthcare (EviCore) administers several of EmblemHealth's utilization management programs, which include the EmblemHealth Radiation Therapy program, the EmblemHealth Cardiology Imaging program and the EmblemHealth Radiology Program.

We're here to help! Thank you for submitting. You will be contacted by an eviCore representative within 5 business days. If you do not hear back from us within 5 business days, please call 800-792-8744, option4.

If the level of review is an appeal you will receive a determination within the standard 30 days, or earlier based on state or federal requirements, as defined in the appeal rights of the initial decision notice. If you do not hear from eviCore within the standard 30 days, please call 800-792-8744, option 4.

Simply visit the eviCore's Provider's Hub page and select the health plan and solution option for your case in the training section. The instructions on how to submit a case and a link to the correct portal to use will be provided.

eviCore works with health plans to help their members like you avoid unnecessary care that is costly and potentially unsafe. We do that by applying the latest evidence-based medical guidelines through a process sometimes referred to as prior authorization.

The prior authorization process uses evidence-based clinical guidelines to ensure that every health plan member receives the most appropriate care while avoiding unnecessary exposure to potentially harmful substances, as well as additional costs.

Please contact us at (800) 918-8924 to change the CPT code on your request. You can also email our team at webcontactrequests@evicore.com. Please continue to share your feedback, suggestions, and questions about our prior authorization process by contacting us at providernewsletter@evicore.com.