Prior Authorization Reference Guide

The purpose of these guides is to inform you of services that require prior authorization. To obtain authorization, please fax the appropriate prior authorization request form to 401-459-6023. The fax line is accessible 24 hours per day, seven days a week. If you have any questions about the authorization process, please call Utilization Management at 401-459-6060.

• Access our Authorization Request forms here.

Radiology Authorization Information

eviCore Radiology Authorizations

Neighborhood has partnered with eviCore healthcare for prior authorization of outpatient elective CT, MR, PET, CT Cardiac, MR Cardiac, PET Cardiac, Nuclear Cardiology and 3D Rendering Procedures.

Please note: Neighborhood and eviCore will accept authorizations from either the ordering or rendering provider prior to the service being rendered.

Additional resources:

• Quick Reference Guide
• CPT list
• FAQs 

For more information visit eviCore.

If you do not find a specific service listed on these guides, it may be that the service is a non-covered benefit. If you need information related to covered services, please refer to our Billing Guidelines and Coverage Summaries or call Neighborhood Member Services at 1-800-459-6019.