Get Requesting Authorization From Evicore Healthcare

This guide provides comprehensive instructions on completing the Requesting Authorization From EviCore Healthcare form online. Follow these steps to ensure a smooth and efficient process for your authorization requests.

Follow the steps to complete your authorization request efficiently.

1. Press the ‘Get Form’ button to access the authorization form and open it in your editor.
2. Begin by entering the member's plan name to identify the patient's insurance.
3. Fill in the patient's details, including their name, date of birth, and member ID to ensure accurate identification.
4. Provide the ordering physician's information, including their name, National Provider Identifier (NPI), address, along with telephone and fax numbers for communication.
5. Enter the facility's information, including its name, telephone, and fax number, which are necessary for processing the authorization.
6. List the requested tests, using CPT codes or descriptions, to specify the procedures requiring authorization.
7. Outline the working diagnosis and include relevant signs and symptoms to support the authorization request.
8. Provide results of any relevant tests and medications the patient is currently taking to facilitate a thorough review.
9. Review all entries for accuracy, ensuring all required fields are completed.
10. Once satisfied, save changes to the form, then download, print, or share the form as needed.

Start your request for authorization online to expedite the process.