EviCore Medical Review Programs

EviCore Specialty Drug Prior Authorization

Effective March 1, 2025, as part of our Medical Specialty Drug Prior Authorization Program, EviCore will review specialty drug authorizations for certain medical drugs that are bought, billed and administered in an outpatient setting, or gene therapies in an inpatient setting, including review of appropriateness of units billed. Learn more »

Enhancement to the Benefit Funds’ Medical Oncology Review Program

The 1199SEIU Benefit Funds’ Medical Oncology Review Program accepts prior authorization requests for standard of care medical oncology drugs administered during pediatric and adult medical oncology clinical trials through EviCore (effective January 1, 2023). To submit your requests, visit the EviCore website or call (888) 910-1199.

EviCore

The Benefit Funds have partnered with EviCore (formerly CareCore National) to pre-authorize and review claims for high-tech radiology and nuclear cardiology scans, radiation therapy, medical oncology treatments and certain outpatient molecular and genomic laboratory services. This partnership allows providers to access EviCore’s experts, as well as their nationally recognized evidence-based guidelines and criteria, to help ensure that 1199SEIU patients receive clinically appropriate care in a timely manner.

Each program has its own page (see below), which includes specific requirements and key information. As our programs are subject to updates, we encourage you to view the program pages on a regular basis to ensure you have the most up-to-date information.

In addition to prior authorization, eviCore will review claims for coding accuracy and medical necessity. We urge you to update your claims submission system and coding practices accordingly to avoid payment delays or unnecessary denials.

Program Details and Resources

Access EviCore's 1199SEIU provider web page »

Save Time and Receive an Immediate Response! Submit Your EviCore Prior Approval Requests Electronically

EviCore offers immediate responses (including email notifications) through its online portal for authorization requests that meet the 1199SEIU Benefit Funds’ criteria.

Sign in or register for EviCore »