Evicore pet 2026

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The document is a Clinical Certification Request form for cardiac imaging procedures including CT, MRI, and PET scans. It outlines the necessary patient and provider information required for both urgent and non-urgent requests, emphasizes the importance of providing complete medical records to avoid delays, and includes sections for clinical information related to symptoms and diagnoses. Additionally, it contains confidentiality notices regarding the handling of sensitive health information.

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Click ‘Get Form’ to open the evicore pet document in the editor.
Begin by filling out the 'Patient/Member' section. Enter the patient's first name, last name, middle initial, date of birth, gender, and contact information including home and cell phone numbers.
Next, complete the 'Ordering Provider' section. Provide details such as the provider's name, TIN, primary specialty, and contact information.
In the 'Facility/Site' section, input the facility's name and address along with relevant contact details.
Proceed to the 'Procedure' section where you will check applicable CPT codes and provide diagnosis information if known.
Finally, review all sections for accuracy. Add any additional comments in the provided space before submitting your request.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the purpose of EviCore?

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.

What is the cost of a cardiac PET scan?

PET scan cost by type PET Scan TypeAverage Cost Cardiac PET scan $1,159 to $2,0485 Inpatient hospital PET/CT scan (various) $7,2756 Outpatient PET/CT scan (various) $2,5506 PSMA PET/CT scan $4,350 to $6,52674 more rows Jul 8, 2024

Does EviCore send approval letters?

The member will receive an approval letter by mail. How will the authorization determinations be communicated to the providers? eviCore will fax the authorization and/or denial letter to the requesting provider. Providers may also visit .evicore.com to view the authorization determination.

What insurance company uses EviCore?

As of 2024, over one hundred insurance companies outsourced utilization review to EviCore, including Aetna, Blue Cross Blue Shield, and UnitedHealthcare, as well as some states Medicaid programs.

Is EviCore a real company?

EviCore by Evernorth is a medical benefits management company owned by Cigna. It is based in Bluffton, South Carolina, United States. The company reviews prior authorizations for specialized medical procedures on behalf of insurers.

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Why am I receiving a letter from EviCore Healthcare?

If the request from your healthcare provider doesnt meet the evidence-based clinical guidelines, youll receive a letter from eviCore letting you know it wasnt approved and why.

Is PET the same as NUC Med?

What is positron emission tomography (PET)? Positron emission tomography (PET) is a type of nuclear medicine procedure that measures metabolic activity of the cells of body tissues. PET is actually a combination of nuclear medicine and biochemical analysis.

Evicore pet 2026

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