Evicore treatment request 2025

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The document is a clinical worksheet for requesting physical therapy (PT) and occupational therapy (OT) treatments for patients with musculoskeletal conditions. It outlines the necessary information to be provided by the ordering provider, including patient details, diagnosis, treatment history, and specific clinical findings. The form emphasizes the importance of submitting complete and accurate information to avoid delays in authorization and includes confidentiality notices regarding patient data.

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What is the phone number for eviCore prior authorization?

To request an authorization: Call eviCore at 1-888-693-3211.

What is eviCore 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.

What does eviCore handle?

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.

1 800 792 8744

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How do I appeal eviCore denial?

Information regarding appeal options, and with whom an appeal should be filed, can be found in the determination letter. You can also contact eviCore healthcare via the telephone number provided on the determination letter, to understand what appeal options are available at the time of your inquiry.

What is the phone number for eviCore appeal?

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.

Is eviCore a Cigna?

eviCore healthcare partners with Cigna to provide industry-leading benefit management solutions for key medical segments, including advanced radiology imaging, diagnostic cardiology, radiation therapy, and musculoskeletal services.

What is the phone number for eviCore members?

Were 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.

How do I contact eviCore?

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

Evicore treatment request 2025

Here's how it works

The easiest way to edit Evicore treatment request in PDF format online

Complete this form in 5 minutes or less

Got questions?

Can I type my eSignature on my [KEY]?

How do you complete [KEY] online?

What is the phone number for eviCore prior authorization?

What is eviCore authorization?

What does eviCore handle?

Complete this form in 5 minutes or less

People also ask

How do I appeal eviCore denial?

What is the phone number for eviCore appeal?

Is eviCore a Cigna?

What is the phone number for eviCore members?

How do I contact eviCore?

evicore appeal form

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