Prominence Health Plan Implementation Resources

EviCore by Evernorth is no longer managing Radiology and Cardiology prior authorization requests for Prominence Health Plan members for dates of service after 12/19/2025. All requests for dates of service on or before 12/19/2025 will be handled by EviCore. All retro authorization requests and requests for dates of service on or after 12/19/2025 will be managed by Prominence Health Plan. For any questions, please contact Prominence Health Plan using the phone number on the back of the member’s ID card

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.