Skip Ribbon Commands
Skip to main content

Prior Authorization Guidelines
for NHP plans and members.

At your fingertips: Below please find our Prior Authorization Guidelines for all services that customarily require prior authorization and/or notification.

Limited benefit information has been included when this information is necessary to support a prior authorization, notification, or referral requirement.

Sleep Management Program

Sleep study requests and authorizations, as well as CPAP equipment, may be obtained by visiting the Sleep Management Solutions website.

Utilization Management Programs through eviCore Healthcare

UM Programs Requiring Authorization (Link to Prior Authorization Code PDFs)

Authorizations can be requested through eviCore Healthcare


Phone: 1-888-693-3211 (toll-free), 8 AM to 9 PM ET

Clinical Guidelines

Cardiology, Ultrasound, High-Tech Radiology Imaging

Lab Management (Molecular & Genetic Testing)

Radiation Therapy