Medical Mutual - Health Plans for Life

Prior Approval & Investigational Services Resources

Please select the appropriate Prior Approval & Investigational Services list to view based on the plan-type of the patient/member:

Individual & Family Plans (Commercial Plans)

Medicare Advantage Plans - 2017

Notice of Changes to Prior Authorization Process

What Is Changing

We are partnering with eviCore healthcare (eviCore) to manage the prior authorization process for radiology services for our fully insured and self-funded group members, including those in commercial, individual and Medicare Advantage plans.

  • The effective date for the updated requirements begins with dates of service on or after January 1, 2018. eviCore will begin accepting reviews on December 18, 2017.
  • Prior to these dates, there are no changes in requirements and providers should continue to submit requests to Medical Mutual directly as they do today for imaging services.
  • After the effective date, services performed without an authorization will be denied for payment, and seeking reimbursement from members is not permitted.
  • Please refer to the Current Procedural Terminology (CPT®) code list of expanded radiology services or evicore.com/healthplan/MedMutualOH.
  • Providers should verify if authorization exists before they provide services. Services performed in conjunction with a 23-hour observation, emergency room visits or inpatient hospital stays are not subject to prior authorization requirements.

Requesting Prior Authorization

To request prior authorization access the eviCore web portal and build a case at https://www.evicore.com/pages/providerlogin.aspx. Prior authorizations will be accepted 24 hours a day, seven days a week, excluding planned down time for system maintenance through the eviCore website, or by phone at (888) 693-3211 or fax to (888) 693-3210. eviCore will provide a voice message service for telephone requests received outside the normal operating hours of 8 a.m. to 9 p.m. E.T., Monday through Friday.

For additional information regarding this change and medically urgent requests, please read the eviCore Quick Reference Guide or visit evicore.com/healthplan/MedMutualOH. To register for prior authorization requests visit eviCore’s website portal https://www.evicore.com/pages/providerlogin.aspx.

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