[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-288832-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-288832-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","evicore-healthcare-radiology-program-frequently-asked-questions","eviCore Healthcare Radiology Program - Frequently Asked Questions","","eviCore healthcare provides utilization management for select outpatient radiology studies for Neighborhood Health Plan of Rhode Island, with prior authorization required for covered services. The FAQ explains who is managed under the program, how to submit authorization requests via web portal, phone, or fax, and how to verify status. It lists required member, ordering provider, facility, and clinical information, covered procedure categories, authorization number format, decision timelines, notifications, validity, urgent handling, retrospective rules, and appeal submission methods.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/letters/","Letters",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/evicore-healthcare-radiology-program-frequently-asked-questions/288832/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/evicore-healthcare-radiology-program-frequently-asked-questions/288832.png","ImageObject",442,249,{"name":42,"@type":43},"Mabel","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-08","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",12,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Which members will eviCore healthcare manage for the outpatient radiology services program?","Question",{"text":63,"@type":64},"eviCore manages radiology services for all Neighborhood Health Plan of Rhode Island members except Extended Family Planning (EFP) members.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How can a prior authorization request be initiated?",{"text":68,"@type":64},"The quickest option is the 24/7 self-service web portal. Prior authorization can also be obtained by telephone at 1-888-693-3211 or by fax at 1-888-693-3210.",{"name":70,"@type":61,"acceptedAnswer":71},"What information is needed to get approval for radiology services?",{"text":72,"@type":64},"Approval requires the member’s details, ordering physician information (including NPI and TIN), rendering facility details, the requested service (CPT and diagnosis codes), and all relevant clinical notes such as imaging/X-ray reports, patient history, and physical findings.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},288832,1790220475,{"code":4,"msg":82,"data":83},"success",[84,89,93,98,103,108,113,117,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":55,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":110,"show_sort_weight":111,"slug":112},17,"Forms",40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":115,"slug":116},18,30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":114,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":22},7971474920318,"https://ap-avatar.wpscdn.com/avatar/74000ee537e6b0ca360?x-image-process=image/resize,m_fixed,w_180,h_180&k=1788430171632181674","| eviCore healthcare Radiology Program\u003Cbr>Frequently Asked Questions\u003Cbr>Who is eviCore healthcare?\u003Cbr>eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for select radiology studies for Neighborhood Health Plan of Rhode Island (Neighborhood) .\u003Cbr>Which members will eviCore healthcare manage for the outpatient radiology services program?\u003Cbr>eviCore will manage radiology services for all Neighborhood Health Plan of Rhode Island members, except Extended Family Planning (EFP) members.\u003Cbr>How can I initiate a prior authorization request?\u003Cbr>The quickest, most efficient way to obtain prior authorization is through the 24/7 self-service web portal [at](at www.evicore.com. Prior authorization)[ ](at www.evicore.com. Prior authorization)[www.evicore.com](at www.evicore.com. Prior authorization)[. Prior authorization](at www.evicore.com. Prior authorization) can also be obtained via telephone at 1-888-693- 3211 or fax at 1-888-693-3210.\u003Cbr>Is it possible for the physician to be both the referring and the rendering provider?\u003Cbr>Yes. This is allowed under the program guidelines.\u003Cbr>What are the hours of operation for the prior authorization department at eviCore?\u003Cbr>eviCore healthcare’s prior authorization call center is available from 8:00 [a.m. to 9:00](a.m. to 9:00) p. m. Eastern Standard Time, Monday through Friday. The telephone number is 1-888-693-3211. The web portal is available for access 24/7 .\u003Cbr>What information is needed in order to get approval for radiology services?\u003Cbr>􀁸 Member’s name, date of birth, plan name and plan ID number\u003Cbr>􀁸 Ordering physician’s name, National Provider Identifier (NPI), Tax Identification Number (TIN), and Fax number\u003Cbr>􀁸 Rendering facility’s name, NPI, TIN, street address, and fax number\u003Cbr>􀁸 Service being requested (CPT codes and diagnosis codes)\u003Cbr>􀁸 All relevant clinical notes; imaging/X-ray reports; patient history; physical findings\u003Cbr>|  |\n| --- | --- |\n| What procedures are included in the program?\u003Cbr>􀁸 CT/CTA\u003Cbr>􀁸 MR/MRA\u003Cbr>􀁸 PET and PET/CT\u003Cbr>􀁸 Nuclear Medicine\u003Cbr>􀁸 3D Rendering Procedures | |\n\nWho can request a prior authorization?  \nA representative of the ordering physician’s staff can ask for authorization. This could be someone from the clinical, front office or billing staff acting on behalf of the ordering physician.  \nHow do providers check for the authorization status of a member?  \nYou can check the authorization via the portal at [www.evicore.com](www.evicore.com) or via telephone at 1-888- 693-3211.  \nWhat is the format of the eviCore healthcare authorization number?  \nAn authorization number is one (1) alpha character followed by seven (7) numbers, and then the CPT code of the procedure authorized. For example: N1234567 .  \nOnce I ask for a prior authorization, how long will it take to get a decision?  \nIn many cases, especially when complete clinical information is submitted initially , providers can receive a real-time approval. If clinical review is needed, in most cases, eviCore will make a decision within two (2) business days of receipt of all necessary information.  \nHow will all parties be notified if the prior authorization has been approved or denied?  \nReferring providers and rendering facilities will be notified in writing by fax. Providers can validate a prior authorization by using the eviCore website or by calling eviCore Customer Service. Members will be notified by mail.  \nIf a prior authorization is not approved, what follow-up information will the referring provider receive?  \nIf a prior authorization request is not approved your notification letter will include the denial rationale, how to request a peer-to-peer discussion, and your appeals rights.  \nHow long is an authorization valid?  \nAuthorizations are valid for ninety (90) calendar days from the date of the request.  \nWhat is the most effective way to get authorization for urgent requests?  \nThe most efficient way","cbCaifxKhg1sNTSw","https://ap.wps.com/l/cbCaifxKhg1sNTSw","pdf",183843,"English","# Frequently Asked Questions\n## Prior authorization requests and status\n## Information required for approval\n## Covered procedures and authorization details\n## Decisions, notifications, timelines, and validity\n## Appeals and special cases","[{\"question\":\"Which members will eviCore healthcare manage for the outpatient radiology services program?\",\"answer\":\"eviCore manages radiology services for all Neighborhood Health Plan of Rhode Island members except Extended Family Planning (EFP) members.\"},{\"question\":\"How can a prior authorization request be initiated?\",\"answer\":\"The quickest option is the 24/7 self-service web portal. Prior authorization can also be obtained by telephone at 1-888-693-3211 or by fax at 1-888-693-3210.\"},{\"question\":\"What information is needed to get approval for radiology services?\",\"answer\":\"Approval requires the member’s details, ordering physician information (including NPI and TIN), rendering facility details, the requested service (CPT and diagnosis codes), and all relevant clinical notes such as imaging/X-ray reports, patient history, and physical findings.\"}]","eviCore Healthcare Radiology Program - Frequently Asked Questions | PDF",1789634052]