Prominence Health Plan Implementation Resources

EviCore by Evernorth is pleased to announce its partnership with Prominence Health Plan Medicare Advantage to provide authorization services for members. For dates of service beginning November 14, 2022, EviCore coordinates prior authorization for the following services for Medicare Advantage:

• Radiology

• Cardiovascular 

• Gastroenterology

• Physical Therapy

• Occupational Therapy

• Spine Surgery Management

• Joint Surgery Management

• Interventional Pain Management

• Durable Medical Equipment

Beginning November 1st, 2016, Prominence Health Plan will require prior authorization from EviCore for commercial members. Services performed without authorization may be denied for payment, and you may not seek reimbursement from members. Authorization is required for the following services:

• CT/CTA

• MRI/MRA

• Nuclear Medicine

• Myocardial Perfusion Imaging

• Echo

• Stress Echo

• Cardiac Rhythm Implantable Devices

• Sleep Diagnostics & Therapy Support

• PAP Therapy Devices & Supplies

• Spine Surgery Management

• Joint Surgery Management

• Interventional Pain Management

• Medical Oncology

• Genetic Lab

• PET

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