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  • Evicore Healthcare Emblem/hip Skilled Nursing Facility Concurrent Review Authorization Form 2019

Get Evicore Healthcare Emblem/hip Skilled Nursing Facility Concurrent Review Authorization Form 2019-2025

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Contact support

Please contact us at (800) 918-8924 to change the CPT code on your request. You can also email our team at webcontactrequests@evicore.com. Please continue to share your feedback, suggestions, and questions about our prior authorization process by contacting us at providernewsletter@evicore.com.

The prior authorization process uses evidence-based clinical guidelines to ensure that every health plan member receives the most appropriate care while avoiding unnecessary exposure to potentially harmful substances, as well as additional costs.

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.

Simply visit the eviCore's Provider's Hub page and select the health plan and solution option for your case in the training section. The instructions on how to submit a case and a link to the correct portal to use will be provided.

If the level of review is an appeal you will receive a determination within the standard 30 days, or earlier based on state or federal requirements, as defined in the appeal rights of the initial decision notice. If you do not hear from eviCore within the standard 30 days, please call 800-792-8744, option 4.

We're here to help! Thank you for submitting. You will be contacted by an eviCore representative within 5 business days. If you do not hear back from us within 5 business days, please call 800-792-8744, option4.

eviCore healthcare (EviCore) administers several of EmblemHealth's utilization management programs, which include the EmblemHealth Radiation Therapy program, the EmblemHealth Cardiology Imaging program and the EmblemHealth Radiology Program.

If the request from your health care provider does not meet evidence-based guidelines, you will receive a letter from eviCore letting you know why the request was not approved. The letter will include a reference to the clinical guidelines in question, which are transparent and available here for your review.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232