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  • Musculoskeletal Solution Evidence-based Medicine Evicore

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Musculoskeletal Benefit Management: Pain Management Prior Authorization and Medical Necessity Determination Request FormOrdering ProviderPatient/MemberFor NONURGENT requests, please fax this completed.

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eviCore is a medical benefits management company which helps patients avoid unnecessary care that can be expensive and potentially unsafe.

Navigating the letter you receive(d) from eviCore If the request from your healthcare provider doesn't meet the evidence-based guidelines, you'll receive a letter from eviCore letting you know it wasn't approved and why it was denied.

You can also email us at portal.support@evicore.com, or reach us by phone at 800-646-0418, option 2.

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.

eviCore's representatives are calling to offer choices about where you can receive your medical scan. Many of our partner health plans offer their members additional information about cost-effective and convenient locations.

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.

eviCore healthcare will render a decision on a routine prior authorization request within 14 calendar days of the original request. However, the usual turnaround time is a few days.

Who is eviCore healthcare? eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for Cigna Medicare Advantage.

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© Copyright 1997-2025
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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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 workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
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