When to get prior authorization through eviCore healthcare
AmeriHealth Caritas New Hampshire has contracted with eviCore healthcare, an independent specialty medical benefits management company, to provide utilization management for certain services. Prior authorization requests for these services will be reviewed by eviCore for medical necessity and must be approved before services are rendered. Prior authorization from eviCore healthcare is required for the following services:
- Durable medical equipment
- Genetic testing
- Home-based physical and occupational therapy
- Joint and spine surgery
- Medical oncology
- Occupational therapy
- Pain management
- Physical therapy
- Diagnostic sleep testing
- Radiation oncology
Note: If treatment started before July 1, 2023, eviCore will honor existing approved authorizations. Please contact eviCore to request a continuation or new series.
To request prior authorization
- Log on to www.evicore.com/pages/ProviderLogin.aspx, 24 hours, seven days a week. This is the quickest way to obtain information.
- Call toll-free 1-877-506-5193.
- Fax additional clinical information to:
- Joint and spine surgery, medical oncology, pain management, radiation therapy:
1-800-540-2406 - Genetic testing: 1-844-545-9213
- Diagnostic sleep testing and sleep DME: 1-866-999-3510
- Physical and occupational therapy: 1-855-774-1319
- Durable medical equipment (DME): 1-866-663-7740
- Joint and spine surgery, medical oncology, pain management, radiation therapy:
For urgent requests:
If a member requires services in less than 48 hours due to medically urgent conditions, please contact eviCore for an urgent review by calling 1-877-506-5193 or submit a request online at www.evicore.com.
eviCore healthcare Clinical Guidelines and forms are available at www.evicore.com.
For additional information and training resources visit
www.evicore.com/resources/healthplan/amerihealth-caritas-family-of-companies [evicore.com].
If you have questions, call eviCore healthcare at 1-800-646-0418 (Option 4), or you can call Provider Services at: 1-888-599-1479.
Disclaimer
Prior authorization is not a guarantee of payment for the service(s) authorized. AmeriHealth Caritas New Hampshire reserves the right to adjust any payment made following a review of, the medical record and/or determination of medical necessity of the services provided. Additionally, payment may also be adjusted if the member’s eligibility changes between when the prior authorization was issued, and the service was provided.