eviCore Prior Authorization Program

Select Health of South Carolina has contracted with eviCore healthcare, an independent specialty medical benefits management company, to provide utilization management for certain services. Prior authorization requests will be reviewed by eviCore for medical necessity and must be approved before services are rendered for the following:

  • Diagnostic sleep testing.
  • Durable medical equipment (DME).
  • Genetic testing.
  • Joint and spine surgery.
  • Medical oncology.
  • Occupational therapy.
  • Pain management.
  • Physical therapy.
  • Radiation oncology.

Note: If treatment started before May 1, 2023, eviCore will honor existing approved authorizations. Please contact eviCore to request a continuation or new series.

To request prior authorization

  • Log on to www.evicore.com/pages/ProviderLogin.aspx, 24 hours, 7 days a week. This is the quickest way to obtain information.
  • Call toll-free: 1-877-506-5193.
  • Fax additional clinical information:
    • Joint/Spine Surgery, Medical Oncology, Pain Management, Radiation Therapy: 1-800-540-2406
    • Genetic Testing: 1-844-545-9213
    • Diagnostic Sleep Testing and Sleep DME: 1-866-999-3510
    • Physical and Occupational Therapy: 1-855-774-1319
    • DME: 1-866-663-7740

For expedited requests:

If a member requires services in less than 72 hours due to medically urgent conditions, please submit a request online at www.evicore.com and indicate that the procedure is NOT routine/standard. Expedited requests can also be made by calling the toll-free number, 1-877-506-5193. Be sure to tell the representative that the request is for medically urgent care.

Beginning April 11, 2023, eviCore healthcare will be leading live online orientation sessions designed to assist you and your staff with the new medical treatment programs. These sessions will include detailed information about the prior authorization process, accessing information from the eviCore website, and a question-and-answer period.

eviCore healthcare clinical guidelines, forms, training resources, orientation schedule and registration details, and additional information are available at: www.evicore.com/resources/healthplan/first-choice-by-select-health/sc/first-choice-by-select-health-of-south-carolina-inc.

For questions, please contact eviCore healthcare at 1-800-646-0418 (Option 4) or Select Health Provider Services at 1-800-741-6605.

Prior authorization is not a guarantee of payment for the service(s) authorized. Select Health reserves the right to adjust any payment made following a review of the medical record and/or determination of medical necessity of the services provided. Additionally, payment may also be adjusted if the member’s eligibility changes between when the prior authorization was issued and the service was provided.