How to obtain Prior Authorization for Molecular Genomic Testing
Posted on July 31, 2017
Referring providers and laboratories may submit prior authorization requests or verify authorization status by contacting eviCore as follows:
- Online by visiting eviCore’s website at: www.evicore.com and logging into the Provider login after completing a free registration. The site is available 24 hours a day, 7 days a week and it is possible to obtain immediate authorization decisions if the coverage criteria are met.
- Via telephone by calling eviCore toll free (888-693-3211), Monday through Friday from 7a.m. to 7p.m. EST.
For those cases that do not receive immediate authorization, eviCore’s Certified Genetic Counselors will review and issue an authorization if the requested test meets the established evidence-based criteria. All other requests will be sent to an eviCore Medical Director for review and determination. All decision will be made within 2 business days for non-urgent requests once complete clinical information is received. All determination decisions will be sent in writing to the member, ordering provider, and laboratory if available. Urgent requests must be clinically warranted and submitted telephonically. When initiating the case, the caller must clearly sate that the request is “Urgent”.
All adverse determination appeals related to the Prior Authorization of tests must be submitted by mail, fax or email to:
eviCore Appeals Dept
400 Buckwalter Place Blvd,
Bluffton, SC 29910
Fax: 866-699-8128
If you are unable to participate in a session, you can obtain a copy of the presentation as well as other important documents at https://www.evicore.com/healthplan/HNE_lab.
Documents are available in PDF format. If you need Adobe Reader, you can download it from www.adobe.com/products/reader/. To receive important announcements and updates via email, please send your contact information to providernewsletter@evicore.com.
If you have any questions regarding any of the included information, please contact Provider Relations at (800) 842-4464, ext 5000. A representative is available Monday – Friday 8am to 5pm, EST.
