eviCore Prior Authorization Program

AmeriHealth Caritas Florida has contracted with eviCore healthcare, an independent specialty medical benefits management company, to provide utilization management for certain services. Prior authorization requests for these services will be reviewed by eviCore for medical necessity and must be approved before services are rendered. Prior authorization from eviCore healthcare is required for the following services:

  • Genetic Testing
  • Joint & Spine Surgery
  • Medical Oncology
  • Occupational Therapy
  • Pain Management
  • Physical Therapy
  • Diagnostic Sleep Testing
  • Radiation Oncology

Note: If treatment started before June 1, 2023 eviCore will honor existing approved authorizations. Please contact eviCore to request a continuation or new series.

To request prior authorization

  • Log on to www.evicore.com/pages/ProviderLogin.aspx, 24 hours, 7 days a week and the quickest way to obtain information,
  • Call toll-free 1-877-506-5193
  • Fax additional clinical information:
    • Joint and Spine Surgery, Medical Oncology, Pain Management, Radiation Therapy:
    • Genetic Testing: 1-844-545-9213
    • Physical and Occupational Therapy: 1-855-774-1319

For urgent requests:

If a member requires services in less than 48 hours due to medically urgent conditions, please contact eviCore for an urgent review by calling 1-877-506-5193 or submit a request online at www.evicore.com.

eviCore health care Clinical Guidelines and forms are available at www.evicore.com

For additional information and training resources visit: 

www.evicore.com/resources/healthplan/amerihealth-caritas-family-of-companies [evicore.com]

If you have questions call eviCore healthcare at 1-800-646-0418 (Option 4), or you can call Provider Services at 1-800-617-5727.

Prior authorization is not a guarantee of payment for the service(s) authorized. AmeriHealth Caritas Florida reserves the right to adjust any payment made following a review of, the medical record and/or determination of medical necessity of the services provided. Additionally, payment may also be adjusted if the member’s eligibility changes between when the prior authorization was issued and the service was provided.