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It explains how CareFirst Commercial Fully Insured members’ identified procedures require prior authorization and how providers use the CareFirst Provider Portal (CareFirst Direct) to access EviCore’s Prior Authorization Lookup (PAL) Tool. The guide details case initiation steps, includes key EviCore phone and fax contacts, links to clinical guidelines and worksheets, and covers scheduling clinical consultations and submitting additional clinical information via ECRM.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/carefirst-quick-reference-guide-2026-provider-prior-authorization-verification-clinical-resources/640716/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/carefirst-quick-reference-guide-2026-provider-prior-authorization-verification-clinical-resources/640716.png","ImageObject",300,407,{"name":92,"@type":93},"Sophia Brooks","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-27","2026-10-22",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Which CareFirst members require prior authorization, and what procedures does this apply to?","Question",{"text":112,"@type":113},"CareFirst Commercial Fully Insured members require prior authorization for the identified procedures listed in the guide.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How do providers verify prior authorization requirements using the PAL Tool?",{"text":117,"@type":113},"Log into the CareFirst Provider Portal (CareFirst Direct), open the Prior Auth/Notifications tab, and use the Prior Authorization Lookup (PAL) Tool accessed through the EviCore transfer option.",{"name":119,"@type":110,"acceptedAnswer":120},"How can a provider schedule a Clinical Consultation through EviCore?",{"text":121,"@type":113},"In the CareFirst Provider Portal, select the Prior Auth/Notification tab, transfer through the EviCore option, choose Clinical Review Lookup to check eligibility for peer-to-peer consultation, then follow the displayed scheduling link.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},640716,1793091246,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":39,"preview_page_count":4},962084925636,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Quick Reference Guide  \nEviCore Provider Resources  \n\n|  Link:  |  [https://www.evicore.com/resources/healthplan/carefirst](https://www.evicore.com/resources/healthplan/carefirst)  |\n| --- | --- |\n\nCareFirst Member Eligibility/Prior Authorization Verification  \nLink: • CareFirst Commercial Fully Insured members require prior authorization for  \nthe identified procedures. To verify prior authorization requirements, log into the CareFirst Provider Portal (CareFirst Direct) , and navigate to the ‘Prior Auth/Notifications’ tab to access the ‘Prior Authorization Lookup (PAL) Tool’.  \n• If you need assistance utilizing the tool, access this step-by-step guide  \nCase Initiation  \n\n| Portal: | To access CareFirst’s Provider Portal:\u003Cbr>• From CareFirst’s Provider Website, [http://provider.carefirst.com](http://provider.carefirst.com) , log into the CareFirst Provider Portal (CareFirst Direct) .\u003Cbr>• Select the Prior Auth/Notification tab.\u003Cbr>• Select Start within the Cardiovascular, Radiology, Musculoskeletal, and Gastroenterology through EviCore (Commercial Fully Insured Members Only) box to be transferred to EviCore’s Prior Authorization Portal (CareCore National Portal) .\u003Cbr>• From the EviCore’s Prior Authorization Portal landing page, you will see “Request an Auth” in the middle of the screen, please select that option to begin your case request. |  |  |\n| --- | --- | --- | --- |\n| EviCore\u003Cbr>Phone: | 844-303-8450 | EviCore Fax: | 800-540-2406 |\n\nClinical Guidelines  \nClinical  \n\n| \u003Cbr>Link: [https://www.evicore.com/provider/clinical-guidelines](https://www.evicore.com/provider/clinical-guidelines) |\n| --- |\n| Worksheets |\n| \u003Cbr>Link: [https://www.evicore.com/provider/online-forms](https://www.evicore.com/provider/online-forms) |\n\nClient and Provider Services Team  \n\n| Contact: | For assistance with membership, claims, provider network issues, etc. , submit the issue to our dedicated teams via EviCore Communication Relationship Management (ECRM):\u003Cbr>• Access: ECRM Services\u003Cbr>• ECRM educational resources: ECRM Resources | EviCore by Evernorth |\n| --- | --- |\n\n\n|  | \u003Cbr>• Trouble using ECRM? Send an email to: [ECRMSupport@EviCore.com](ECRMSupport@EviCore.com)\u003Cbr>[Common Items to Send to Client Services include:](Common Items to Send to Client Services include:)\u003Cbr>• Questions regarding Accuracy Assessment, Accreditation, and/or Credentialing\u003Cbr>• Requests for an authorization to be resent to the health plan\u003Cbr>• Consumer Engagement Inquiries\u003Cbr>• Complaints and Grievances\u003Cbr>• Eligibility issues (member, rendering facility, and/or ordering physician)\u003Cbr>• Issues experienced during case creation\u003Cbr>• Reports of system issues |\n| --- | --- |\n\nClinical Consultations (scheduled in advance)  \n\n| \u003Cbr>Link: | To schedule a Clinical Consultation through EviCore please follow the below steps:\u003Cbr>• Please visit CareFirst’s Provider Website, [http://provider.carefirst.com](http://provider.carefirst.com), log into the CareFirst Provider Portal (CareFirst Direct) .\u003Cbr>• Select the Prior Auth/Notification tab.\u003Cbr>• Select Start within the Cardiovascular, Radiology, Musculoskeletal, and Gastroenterology through EviCore (Commercial Fully Insured Members Only) box to be transferred to EviCore’s Prior Authorization Portal (CareCore National Portal) .\u003Cbr>• Select “Clinical Review Lookup” to determine if your case is eligible for a Peer-to-Peer consultation, a link will display, allowing you to proceed scheduling without any additional messaging.\u003Cbr>• Once the Request Peer-to-Peer Consultation link is selected, you will be transferred to our scheduling software via a new browser window. |\n| --- | --- |\n| Phone: | 844-303-8450 |\n| EviCore Web Support |  |\n| Link: | \u003Cbr>ECRM Services |\n| Phone: | 800-646-0418, Option 2 |\n| Additional Clinical |  |\n| Link: | If additional information is required, you will need to follow the following steps to upload more clinical for review:\u003Cbr>• Please visit CareFirst’s Provider Website, [http://provider.carefirst.com](h","cbCaidotaZXsy0EX","https://ap.wps.com/l/cbCaidotaZXsy0EX","pdf",184317,"English","# CareFirst Member Eligibility / Prior Authorization Verification\n## Case Initiation\n## Clinical Guidelines\n## Client and Provider Services Team\n## Clinical Consultations (Scheduled in Advance)\n## Additional Clinical Information Submission","[{\"question\":\"Which CareFirst members require prior authorization, and what procedures does this apply to?\",\"answer\":\"CareFirst Commercial Fully Insured members require prior authorization for the identified procedures listed in the guide.\"},{\"question\":\"How do providers verify prior authorization requirements using the PAL Tool?\",\"answer\":\"Log into the CareFirst Provider Portal (CareFirst Direct), open the Prior Auth/Notifications tab, and use the Prior Authorization Lookup (PAL) Tool accessed through the EviCore transfer option.\"},{\"question\":\"How can a provider schedule a Clinical Consultation through EviCore?\",\"answer\":\"In the CareFirst Provider Portal, select the Prior Auth/Notification tab, transfer through the EviCore option, choose Clinical Review Lookup to check eligibility for peer-to-peer consultation, then follow the displayed scheduling link.\"}]","CareFirst Quick Reference Guide 2026 - Provider Prior Authorization Verification - Clinical Resources | PDF",1792710697]