Evicore program form 2025

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The document is a clinical worksheet for massage therapy requests within a musculoskeletal program. It outlines the necessary information required for non-urgent and urgent requests, including patient and provider details, administrative data, diagnoses, pain levels, activity difficulties, and medication usage. The form is designed to facilitate the authorization process for massage therapy services.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (173 Votes)

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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.

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.

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.

Does Medicare use EviCore?

EviCore manages precertification for home health care services for Cigna Medicare Advantage customers with the exception of Arizona Medicare customers. Cigna and EviCore offer a comprehensive oncology program that promotes affordability, predictability, and simplicity.

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.

Why am I getting mail from eviCore?

In the event of clinical urgency, eviCore healthcare will render a decision within 72 hours of the request. What is the decision time limit for a routine prior authorization decision? eviCore healthcare will render a decision on a routine prior authorization request within 14 calendar days of the original request.

What is eviCore used for?

Cigna works with eviCore healthcare (eviCore, formerly CareCore | MedSolutions) to provide high-quality, cost-effective services to Cigna customers in most markets for outpatient, nonemergency, high-technology radiology and diagnostic cardiology services.

Evicore program form 2025

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