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Authorizations
Instructions
Prior Authorization
- For prescriptions, please visit our Pharmacy page.
- For mental health/substance abuse services call BHCP at 1-888-812-7335.
- For both Generations Advantage and US Family Health Plan members, prior authorization may be requested by the member's PCP or by the servicing provider/facility.
- Prior authorization is not required for emergency care.
- Prior authorization requests should be submitted at least 14 calendar days prior to the date of service or facility admission.
- If the servicing provider is not part of the Martin’s Point network, we require a letter of medical necessity (including clinical documentation) explaining why the service(s) can only be provided by this specialist.
- Imaging Services: The following changes to authorization requirements for imaging services will be effective for dates of service on or after October 1, 2020.
- Authorization will no longer be required for :
- Cardiac ECHO, Cardiac Nuclear Stress test and Ultrasound
- Martin’s Point will assume managing authorization for:
- Cardiac CT, Cardiac MRI and Cardiac PET
- eviCore will continue to manage authorizations for:
- Advanced imaging (non Cardiac CT, MRI, PET, Nuclear
- Authorization will no longer be required for :
www.eviCore.com/healthplan/Martins_Point
Retrospective Authorization
Please refer to theForms and Documents section for more information.
Questions? Read more in the Provider Manual or Contact Us.