← Back to list
Update: Medical Information Required When Requesting Prior Authorization (PA) or Medical Necessity Determination (MND) from eviCore
Act
immediately
Effective date
Not stated in the notice
Identified
Oct 3, 2026
Summary
eviCore now requires that all Prior Authorization (PA) and Medical Necessity Determination (MND) requests include specific key medical information. The policy directs providers to consult eviCore's Medical Information Requirements documentation to ensure completeness. eviCore will process standard cases within three business days once all required clinical information is received.
Get alerts when payers change rules like this one
We check Horizon BCBS NJ and other payers every day and email you when a change matches your specialty and state.
Get Horizon BCBS NJ alertsPolicy Monitoring is free. No card required.
What to do
immediately · 3 steps
01Billing and clinical staff must obtain eviCore's Medical Information Requirements documentation (referenced in policy but not provided in this source) and integrate required data elements into all PA/MND submission workflows.
02Update PA request templates, encounter forms, and billing system workflows to capture and validate all mandatory clinical information before submission to eviCore.
03Train staff on new requirements to prevent submission rejections and delays.
If missed: Failure to include required medical information will delay case processing beyond the three-business-day timeline and may result in claim denials or rework.
Original notice
Update: Medical Information Required When Requesting Prior Authorization (PA) or Medical Necessity Determination (MND) from eviCore
horizonblue.com · Always check the source before changing claims.