This website cannot be viewed properly using Internet Explorer.

Viewing the site in Internet Explorer will cause functionality and security issues across the site. To avoid this, please use a modern browser such as Chrome, Firefox, Safari or update Internet Explorer to Microsoft Edge.

Prior Authorization Requests

Important Provider Notice: Utilization Management Team Will Extend Dates of Service for Approved PA Requests

April 24, 2020 – The Office of the Superintendent of Insurance has asked health insurers to minimize prior authorization requirements for COVID-19 testing and related treatment. Consistent with that request, our Utilization Management (UM) team will extend the dates of service for a prior authorization request approved for a service that was delayed or cancelled due to COVID-19.

  • Providers can simply fax an extension request to the UM team at 1-866-446-3774 or call 1-844-508-4677 to request the extension.
  • Providers don’t need to resubmit all the clinical information for an already approved authorization.
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 or the FEHB 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 Portals?
  • Contact the Application Support Team by email at support@evolenthealth.com or by phone at 1-888-959-4031.
  • Identifi Health Plan enhancement: Users now can view authorization requests where the National Provider Identifiers (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?
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.