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  • Evicore Healthcare Medical Drugs Prior Authorization Form

Get Evicore Healthcare Medical Drugs Prior Authorization Form

Medical Drugs Prior Authorization Form Please use this form when requesting prior authorization for medical drugs. Thank you.FAX: ONLINE:8005402406 eviCore.comDATE: PATIENT INFORMATION Member identification.

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Evicore healthcare prior authorization form Questions & Answers

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Contact support

The quickest, most efficient way to obtain prior authorization is through the 24/7 self-service web portal at .evicore.com. Prior authorization can also be obtained via phone at (888) 693-3211 or fax at (888) 693-3210.

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.

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.

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 healthcare will permit retrospective requests. Retrospective requests must be initiated by phone within 7 business days following the date of service. Please have all clinical information relevant to your request available when you contact eviCore healthcare.

You can also email portal.support@evicore.com or call 800-646-0418, option 2.

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.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232