Back to health plan

Affinity Health Plan

You may already be aware eviCore currently manages the authorization process for radiology services for Affinity members. Effective January 1st, 2017, the following services also will be managed by eviCore and will require an authorization:​

You may already be aware eviCore currently manages the authorization process for radiology services for Affinity members. Effective January 1st, 2017, the following services also will be managed by eviCore and will require an authorization:​

Authorization is required for:​​
Nuclear Medicine​​
Ultrasound​​
Sleep Management​​
Speech Therapy​​
Cardiology​​
Cardiac Rhythm Implantable Devices​​
Radiation Therapy​​
​Physical Therapy/Occupational Therapy

Click Here for eviCore's Evidence-Based Clinical Guidelines

Services performed in conjunction with an inpatient stay, 23 hour observation, or emergency room visit are not subject to authorization requirements.

Please check back periodically for updated and/or additional information regarding these new programs.​

Ultrasound

For a routine pregnancy, the first two ultrasounds – nuchal translucency (76813) and fetal anatomy survey (76805) – do not require prior authorization. Any additional ultrasounds will require prior authorization.

Non-obstetric Ultrasounds

The first ultrasound for any one specific condition (example: such as pelvic ultrasound for pelvic pain, thyroid ultrasound for a thyroid mass, renal ultrasound for hematuria) does not require a prior authorization. Any additional ultrasound for the same condition or these previously submitted CPT codes, in a calendar year, will require prior authorization.​

PT/OT/ST

Prior authorization is not required for the first six (6) visits within the benefit period. Visits Seven (7) and beyond will require prior authorization. Please refer to the specific program benefits for limitations. ​

Sleep Study Supplies

Prior authorization is required every 3 months. ​

Need Help?

Registration Instructions

EXPAND

Evidence-Based Clinical Guidelines

ACCESS GUIDELINES