Notifications and Admissions

Disclaimer: All attempts are made to provide the most current information. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding, and billing practices. For specific details, please refer to the provider manual. If you are uncertain that prior authorization is needed, please submit request for an accurate response.

It is important to verify Benefits and Eligibility with Evry Health Plans for all services. The Services listed may be governed by Evry Health Plans Medical Policies, which may impact coverage decisions. All planned admissions and any procedure listed on this website require prior authorization, all unplanned admissions require notification unless otherwise specified.

prior authorization is required before the service is provided in non-emergent situations. Retroactive requests will be denied unless there are extenuating circumstances. All prior authorizations should be requested using Evry Health Plans request form. Supporting documentation (e.g., notes and lab or radiology findings) should be sent with all prior authorization requests.

All Out-of-Network facilities are required to request authorization for further care or treatment needed after the stabilization of an emergency medical condition. Members with health plan benefits which exclude out of network coverage will not be responsible for facility charges where the facility failed to request timely authorization for inpatient and length of stay review. To join our network contact Customer Service 855-579-3879 for provider relations.