Prior Authorization Requests

For Services Covered under the Medical Benefit

You may begin prior authorization requests in one of two ways:

  1. Log in to the Provider Portal to start and/or check on the status of your prior authorizations. By logging in, you agree to our Standard Terms of Use.
  2. Download and complete the Prior Authorization Request Form (new for 2020) and fax it to 1-866-446-3774.

Need Help Submitting Prior Authorizations via Our Provider Portal?

  • Contact the Application Support Team by email at support@evolenthealth.com or by phone at 1-888-959-4031.
  • Watch the Identifi Health Plan training video.
  • June 30 Identifi Health Plan enhancement: With the June 30 release, users will be able to view authorization requests where the NPIs they have access to are listed as the Rendering or Attending provider in addition to Requesting. For details, please view this slide deck.

Urgent and After-Hours Prior Authorization Requests

  • To submit an urgent after-hours prior authorization request, please call our Customer Care Center at 1-844-508-4677 and follow the prompts to reach the after-hours prior authorization nurse.
  • After-hours requests must be submitted verbally and be urgent in nature. We will process routine prior authorization requests during regular business hours.

Which Services Require Prior Authorization?

View a list of healthcare services that do and do not require prior authorization.

 

For Services Covered under the Pharmacy Benefit

To begin prior authorizations for pharmacy, please complete the Prior Authorization Request Form (new for 2020) and fax it to Pharmacy Services at 1-866-718-7938. Providers may also call 1-866-823-1606 for assistance.