Urgent after-hours prior authorization requests

A request is considered urgent if delaying treatment would:

  • Put the patient's life in serious danger
  • Interfere with full recovery
  • Delay treatment for severe pain

Services that generally require prior authorization, such as advanced diagnostic imaging, don't require prior authorization in an emergency room setting.

No auth needed in ER setting

Services that generally require prior authorization, such as advanced diagnostic imaging, don't require prior authorization in an emergency room setting.

Urgent/emergent hospital admissions

Participating hospitals can use our Auth Request tool to notify us of urgent/emergent admissions, deliveries and continuing stays through Clear Coverage™. Go to Auth Request.

Some authorization requests will automatically be authorized/ billable for observation instead of inpatient admissions. Authorization rules for urgent/emergent admissions.

Urgent/emergent behavioral health evaluations

See the behavioral health section.

Urgent/emergent auths available through eviCore

Call eviCore toll-free at 844.303.8456. They'll respond to after-hours requests within 24 hours for Medicare and Medicaid/Healthy Michigan Plan members and within 72 hours for commercial group and individual members.

  • Musculoskeletal services and surgeries, including arthroscopies
  • Spinal procedures and surgeries: Open, percutaneous and endoscopic
  • Genetic testing
  • Advanced diagnostic imaging: CT/CTA, MRI, MRA, nuclear cardiac studies and PET scans

Their office hours are Monday through Friday, 7 a.m. to 7 p.m. Eastern Time. eviCore is closed on Jan. 1, Memorial Day, July 4, Labor Day, Thanksgiving and the Friday after, and Christmas day.

Other urgent/emergent authorizations

  • For all urgent/emergent auth requests from non-participating providers
  • For services not available using Auth Request (drug fills, transfers and other services requiring medical necessity review)
  • For practitioner/vendor requests normally processed by Clear Coverage™

Call us at 800.269.1260. Leave a phone number and message. A nurse care manager will return your call within 30 minutes.