Network Health Wisconsin Provider Resources

EviCore by Evernorth is in partnership with Network Health Wisconsin to provide authorization services for Network Health members.

Outpatient MR, CT, PET, Outcomes Focused Cardiology, including Peripheral Vascular Disease diagnosis and/or intervention procedures, and Lumbar Spinal Fusion Surgery studies require prior authorization from EviCore.

Note: With Lumbar Spinal Fusion Surgery and some joint surgeries, the member may have an inpatient stay. EviCore by Evernorth is limited to authorizing the procedure only. Please submit the request for inpatient hospitalization to Network Health.

Medical Oncology (including Lab), Radiation Therapy, Joint Surgery, Spine Surgery and Interventional Pain services require prior authorization from EviCore by Evernorth.

Physical Therapy, Occupational Therapy and Gastroenterology services require prior authorization from EviCore.

To verify the procedure codes requiring prior authorization, please refer to the program code list under the Solution Resources tab, or the Comprehensive Code List under the General Resources tab