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Advanced Imaging and musculoskeletal utilization management programs

Working with eviCore

We want our members to get the best care for the best cost. And we know you do, too. That’s why we partner with eviCore for prior authorization. eviCore uses evidence-based guidelines for their review process. We trust that our partnership with them supports our members and your work.

Benefits of working with eviCore


Overview of how Moda works with eviCore

Here’s how eviCore’s prior authorization process works


See if your patients require prior authorization
Log in to Benefit Tracker or call our customer service team toll-free at 800-592-8283.

eviCore provides prior authorization reviews for many different services
Most often, eviCore reviews advanced imaging for radiology and cardiology (CT and PET scans, MRIs, etc.) and musculoskeletal services (chiropractic, acupuncture, massage, physical and occupational therapy, etc.). They may review different services for different plans. Please see the following list of CPT codes that require prior authorization:

What to do if a prior authorization isn’t approved

Guide to handling denied prior authorizations

Treatment for autism spectrum disorder and neurodevelopmental conditions
If you have questions about intensive outpatient rehabilitation authorizations for the treatment of autism spectrum disorder or neurodevelopmental conditions, please contact our Healthcare Services team at 800-592-8283.

Tips to help your prior authorization go smoothly

  1. Ask your Moda Health Med PR representative to set up a customized training for your staff and eviCore’s training team
  2. Request a consult with a peer reviewer. Your request will be looked at to make sure it is available for this kind of review. To submit this request, please complete the online form. You will then receive a confirmation email, and eviCore’s Physician Services Unit will contact your office to schedule an appointment time.
  3. Consider using eviCore’s Clinical Worksheets to make sure you are submitting information that meets their guidelines.

Frequently asked questions

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