Preauthorizations Submission Information
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Frequently requested services

The information below explains how to submit a preauthorization for frequently requested services and procedures for your patients with coverage through CarePlus. Select the service to learn how to submit a preauthorization request.

For all other services not listed, please reference the inpatient and outpatient services on the CarePlus Prior Authorization Lists to complete your request online or call the CarePlus Health Services Department at 1-800-201-4305, Monday – Friday, 8 a.m. to 5 p.m., Eastern time.

Non-cardiac ablation services

CarePlus Health Plans reviews non-cardiac (e.g., bone, kidney, liver, prostate, etc.) ablation services preauthorization requests.
 

Submitting preauthorization requests to CarePlus

Evolent Health, formerly New Century Health, reviews cardiac advanced imaging services preauthorization requests.

Evolent Health will evaluate the medical necessity of the service and request necessary medical records. A physician may contact the requesting physician to discuss the preauthorization request. Submit all requests with supporting clinical documentation, including:

  • Date of service
  • Patient name and CarePlus member ID
  • Patient diagnosis (and diagnosis code[s])
  • Provider name, location/address, phone and fax numbers, and National Provider Identifier (NPI)/Tax ID Number (TIN)
  • Requested medication (including dose, frequency, directions for use, and /or CPT code[s])
  • Relevant clinical information, such as:
    • Significant clinical history, including history of present illness, significant comorbidities, current medications, surgical history, key clinical exam findings, and the results of conservative therapy undertaken, in detail, including duration and results


Submitting preauthorization requests to Evolent Health

  • Relevant current imaging reports and other key diagnostic test results
  • Site of administration

Choose from the following options to submit a request for preauthorization:

  • Log on to Evolent Health’s website, enter your username and password, then submit your request. 
    • If you need a username and password, email providertraining@newcenturyhealth.com. Use Access to Evolent Portal and your state (Florida) as the email subject line. Include your TIN, specialty, practice name, contact name, and contact phone number.
  • Fax the required information to 1-714-582-7547
  • Email efax-carepro-cardio@newcenturyhealth.com
  • Call Evolent Health’s intake coordinator department at 1-888-999-7713 and choose option 1, Monday – Friday, 8 a.m. to 8 p.m., Eastern time, Saturdays, 8 a.m. to 8 p.m., and Sundays, 9 a.m. to 5 p.m. Evolent Health is closed on federal holidays.


Non-cardiac advanced imaging services

CarePlus Health Plans reviews non-cardiac advanced imaging services preauthorization requests.


Submitting preauthorization requests to CarePlus

Choose from the following options to submit a request for preauthorization:

Carelon Behavioral Health reviews preauthorization requests for the following behavioral health and substance use services:

  • Clubhouse services, psychosocial rehabilitation services, and/or targeted case management
  • Mental health inpatient hospitalization
  • Partial hospitalization
  • Residential treatment
  • Substance use inpatient hospitalization
  • Transcranial magnetic stimulation (TMS)
     

Submitting preauthorization requests to Carelon Behavioral Health

1. Inpatient/Diversionary authorizations (if applicable): 
Authorizations for new treatment as of the effective date of Jan. 1, 2024, may be obtained via one of the following methods, all of which are available 24 hours, seven days a week:  

  • Via its provider portal – (registration required)
  • Providers can also call: 833-227-3757 (833-CAREPLS)
  • Out-of-network providers: Please call: 833-227-3757 (833-CAREPLS)

2. Outpatient Authorizations (if applicable):
Authorizations for new treatment as of the effective date of Jan. 1, 2024, may be obtained via one of the following methods, all of which are available 24 hours, seven days a week: 

  • Via its provider portal – (registration required)
  • Out-of-network providers: Fax: 800-370-1116 for all non-urgent requests for initiation of treatment.
    • PCP referrals are also required for out-of-network provider requests.

Preauthorization requests can be made 24 hours, seven days a week.

Access preauthorization forms, guides, resources, criteria hierarchy, and clinical practice guidelines

Cardiac services requiring preauthorization include:

  • Aortic repair
  • Atrioventricular node ablation
  • Cardiac ablation
  • Cardiac catheterization
  • Cardiac implantable device
  • Cardiac implantable device (defibrillators)
  • Cardiac implantable device (pacemakers)
  • Cardio MEMS
  • Carotid artery stenting (CAS)
  • Carotid endarterectomy
  • Catheter-based angiogram, lower extremity arteries
  • Electrophysiology study (EPS)
  • Endovascular aortic repair
  • External wearable devices
  • Internal loop recorders
  • LAAC
  • Myocardial perfusion imaging single photon emission computed tomography (MPI-SPECT)
  • Patent foramen ovale (PFO) and atrial septal defect (ASD) closure
  • Percutaneous coronary intervention (PCI)/angioplasty
  • Percutaneous intervention: Angioplasty/atherectomy/stenting
  • Percutaneous thoracic aortic repair
  • Percutaneous ventricular assist devices
  • Peripheral angiography
  • Peripheral revascularization
  • Positron emission topography
  • Stress echocardiogram
  • Surgical revascularization/thromboendarterectomy/peripheral vascular bypass
  • Surgical thoracic aortic repair
  • Transcatheter aortic valve replacement/implantation (TAVR)
  • Transcatheter mitral valve repair
  • Transesophageal echocardiogram (TEE)
  • Transthoracic echocardiogram (TTE)
  • Ventricular assist devices

All remaining authorization requirements remain in effect.

Evolent Health, formerly New Century Health, reviews cardiac services preauthorization requests for patients receiving procedures in South Florida (Broward, Miami-Dade, and Palm Beach counties) and West Florida (Hillsborough, Pasco, and Pinellas counties).

Evolent Health will evaluate the medical necessity of the service and request necessary medical records. A physician may contact the requesting physician to discuss the preauthorization request. Submit all requests with supporting clinical documentation, including:

  • Date of service
  • Patient name and CarePlus member ID
  • Patient diagnosis (and diagnosis code[s])
  • Provider name, location/address, phone and fax numbers, and NPI/TIN
  • Requested medication (including dose, frequency, directions for use, and /or CPT code[s])
  • Relevant clinical information, such as:
    • Significant clinical history, including history of present illness, significant comorbidities, current medications, surgical history, key clinical exam findings and the results of conservative therapy undertaken, in detail, including duration and results
    • Relevant current imaging reports and other key diagnostic test results
  • Site of administration
     

Submitting preauthorization requests to Evolent Health

Choose from the following options to submit a request for preauthorization:

  • Log on to Evolent Health’s website, enter your username and password, then submit your request.
    • If you need a username and password, email providertraining@newcenturyhealth.com. Use Access to Evolent Portal and your state (Florida) as the email subject line. Include your TIN, specialty, practice name, contact name, and contact phone number.
  • Fax the required information to 1-714-582-7547
  • Email efax-carepro-cardio@newcenturyhealth.com
  • Call Evolent Health’s intake coordinator department at 1-888-999-7713 and choose option 1, Monday – Friday, 8 a.m. to 8 p.m., Eastern time, Saturdays, 8 a.m. to 8 p.m., and Sundays, 9 a.m. to 5 p.m. Evolent Health is closed on federal holidays.

CarePlus Health Plans reviews cardiac services preauthorization requests for patients receiving services in West Florida (Hernando and Polk counties only), North Florida (Clay, Duval, and St. Johns counties), the Daytona area (Flagler and Volusia counties), Central Florida (Lake, Marion, Orange, Osceola, Seminole, and Sumter counties), and the Space Coast area (Brevard and Indian River counties).
 

Submitting preauthorization requests to CarePlus

Choose from the following options to submit a request for preauthorization:

Call the CarePlus Health Services Department at 1-800-201-4305, Monday – Friday, 8 a.m. to 5 p.m., Eastern time.

Evolent Health* reviews chemotherapy and supportive drugs preauthorization requests for patients receiving services in South Florida (Broward, Miami-Dade, and Palm Beach counties).

Evolent Health will evaluate the medical necessity of the service and request necessary medical records. A physician may contact the requesting physician to discuss the preauthorization request. Submit all requests with supporting clinical documentation, including:

  • Billing type
  • Date of service
  • Patient name, height and weight, and CarePlus member ID
  • Patient diagnosis (and diagnosis code[s])
  • Provider name, location/address, phone and fax numbers, and NPI/TIN
  • Requested medication (including dose, frequency, directions for use, and /or CPT code[s])
  • Relevant clinical information, such as:
    • Significant clinical history, including history of present illness, significant comorbidities, current medications, surgical history, key clinical exam findings and the results of conservative therapy undertaken, in detail, including duration and results
    • Relevant current imaging reports and other key diagnostic test results
  • Site of administration
     

Submitting preauthorization requests to Evolent Health

Choose from the following options to submit a request for preauthorization:

  • Log on to Evolent Health’s website, enter your username and password, then submit your request.
    • If you need a username and password, email providertraining@newcenturyhealth.com. Use Access to Evolent Portal and your state (Florida) as the email subject line. Include your TIN, specialty, practice name, contact name, and contact phone number.
  • Fax the required information to 213-596-3783
  • Email efax-carepro-oncology@newcenturyhealth.com
  • Call Evolent Health’s intake coordinator department at 1-888-999-7713 and choose option 2, Monday – Friday, 8 a.m. to 8 p.m., Eastern time, Saturdays, 8 a.m. to 8 p.m., and Sundays, 9 a.m. to 5 p.m. Evolent Health is closed on federal holidays.

CarePlus Health Plans reviews chemotherapy and supportive drugs preauthorization requests for patients receiving services in West Florida (Hernando and Polk counties only), North Florida (Clay, Duval, and St. Johns counties), the Daytona area (Flagler and Volusia counties), Central Florida (Lake, Marion, Orange, Osceola, Seminole, and Sumter counties), and the Space Coast area (Brevard and Indian River counties).
 

Submitting preauthorization requests to CarePlus

Choose from the following options to submit a request for preauthorization:

For durable medical equipment (DME) preauthorization requests, CarePlus has 2 delegated vendors for specific service areas: One Homecare Solutions and Integrated Home Care Services.
 

One Homecare Solutions

One Homecare Solutions reviews preauthorization requests for patients receiving services in South Florida (Broward, Miami-Dade, and Palm Beach counties).
 

Submitting preauthorization requests to One Homecare Solutions

Submit a preauthorization request by:

  • Faxing 855-441-6941
  • Calling 855-441-6900, Monday – Friday, 8 a.m. – 9 p.m., and Saturdays, Sundays, and federal holidays from 9 a.m. to 5 p.m. On-call after-hours support is available 24 hours, seven days a week.
     

Integrated Home Care Services

Integrated Homecare Solutions reviews preauthorization requests for patients receiving services in West Florida (Hernando, Hillsborough, Pasco, Pinellas, and Polk counties); North Florida (Clay, Duval, and St. Johns counties); the Daytona area (Flagler and Volusia counties); Central Florida (Lake, Marion, Orange, Osceola, Seminole, and Sumter counties; and the Space Coast area (Brevard and Indian River counties).
 

Submitting preauthorization requests to Integrated Home Care Services

Submit a preauthorization request:

  • Via the Integrated Home Care Services online portal
  • By faxing 844-215-4265
  • By calling 844-215-4264, Monday – Friday, 8:30 a.m. to 7 p.m., and Saturdays from 8:30 a.m. to 5:30 p.m. On-call after-hours answering service is available Monday – Friday, 7 p.m. to 8:30 a.m., and from 5:30 p.m. Saturday to 8 a.m. Monday, and all federal holidays, Eastern time.

Integrated Home Care Services makes available through its online resource center a Referral Source Quick Reference Guide. This guide includes department phone numbers, authorization request forms, and prescription and clinical information.

Services requiring preauthorization include:

  • Capsule endoscopy 
  • Colonoscopy (repeat only)
  • Diagnostic esophagogastroduodenoscopy (EGD) or esophagoscopy
  • Laparoscopic hiatal hernia repair

Health Network One* reviews endoscopy services preauthorization requests for patients receiving services in South Florida (Broward, Miami-Dade, and Palm Beach counties).

Submitting preauthorization requests to Health Network One

Submit preauthorization requests:

  • Through its online portal
  • By faxing 1-866-646-1772
  • By calling 1-800-595-9631, Monday – Friday, 8:30 a.m. to 5 p.m., Eastern time

When submitting a preauthorization request (intake form), please include:

  • Clinical documentation
  • CPT code
  • Diagnosis
  • Member demographic information
  • POS
  • Requesting and referring provider information
  • Type of service

CarePlus Health Plans reviews endoscopy services preauthorization requests for patients receiving services in West Florida (Hernando, Hillsborough, Pasco, Pinellas, and Polk counties), North Florida (Clay, Duval, and St. Johns counties), the Daytona area (Flagler and Volusia counties), Central Florida (Lake, Marion, Orange, Osceola, Seminole, and Sumter counties), and the Space Coast area (Brevard and Indian River counties).

Submitting preauthorization requests to CarePlus

Choose from the following options to submit a request for preauthorization:

Health Network One* reviews gastroenterology services preauthorization requests for patients receiving services in South Florida (Broward, Miami-Dade, and Palm Beach counties).

Submitting preauthorization requests to Health Network One

Submit preauthorization requests:

  • Through its online portal
  • By faxing 1-866-646-1772
  • By calling 1-800-595-9631, Monday – Friday, 8:30 a.m. to 5 p.m., Eastern time

When submitting a preauthorization request (intake form), please include:

  • Clinical documentation
  • CPT code
  • Diagnosis
  • Member demographic information
  • Place of service (POS)
  • Requesting and referring provider information
  • Type of service

CarePlus Health Plans reviews EGD services preauthorization requests for patients receiving services in West Florida (Hernando, Hillsborough, Pasco, Pinellas, and Polk counties), North Florida (Clay, Duval, and St. Johns counties), the Daytona area (Flagler and Volusia counties), Central Florida (Lake, Marion, Orange, Osceola, Seminole, and Sumter counties), and the Space Coast area (Brevard and Indian River counties).
 

Submitting preauthorization requests to CarePlus

Choose from the following options to submit a request for preauthorization:

Evolent Health* reviews hematology/oncology preauthorization requests for patients receiving procedures in South Florida (Broward, Miami-Dade, and Palm Beach counties).

Evolent Health will evaluate the medical necessity of the service and request necessary medical records. A physician may contact the requesting physician to discuss the preauthorization request. Submit all requests with supporting clinical documentation, including:

  • Billing type
  • Date of service
  • Patient name, height and weight, and CarePlus member ID
  • Patient diagnosis [and diagnosis code(s)]
  • Provider name, location/address, phone and fax numbers, and NPI/TIN
  • Requested medication [including dose, frequency, directions for use, and /or CPT code(s)]
  • Relevant clinical information, such as:
    • Significant clinical history, including history of present illness, significant comorbidities, current medications, surgical history, key clinical exam findings and the results of conservative therapy undertaken, in detail, including duration and results
    • Relevant current imaging reports and other key diagnostic test results
  • Site of administration
     

Submitting preauthorization requests to Evolent Health

Choose from the following options to submit a request for preauthorization:

  • Log on to Evolent Health’s website, enter your username and password, then submit your request.
    • If you need a username and password, email providertraining@newcenturyhealth.com. Use Access to Evolent Portal and your state (Florida) as the email subject line. Include your TIN, specialty, practice name, contact name, and contact phone number.
  • Fax the required information to 213-596-3783
  • Email efax-carepro-oncology@newcenturyhealth.com
  • Call Evolent Health’s intake coordinator department at 1-888-999-7713 and choose option 2, Monday – Friday, 8 a.m. to 8 p.m., Eastern time, Saturdays, 8 a.m. to 8 p.m., and Sundays, 9 a.m. to 5 p.m. Evolent Health is closed on federal holidays.

CarePlus Health Plans reviews hematology/oncology preauthorization requests for patients receiving services in West Florida (Hernando, Hillsborough, Pasco, Pinellas, and Polk counties), North Florida (Clay, Duval, and St. Johns counties), the Daytona area (Flagler and Volusia counties), Central Florida (Lake, Marion, Orange, Osceola, Seminole, and Sumter counties), and the Space Coast area (Brevard and Indian River counties).
 

Submitting preauthorization requests to CarePlus

Choose from the following options to submit a request for preauthorization:

For home health care preauthorization requests, CarePlus has 2 delegated vendors for specific service areas: One Homecare Solutions and Integrated Home Care Services.

One Homecare Solutions reviews preauthorization requests for patients receiving services in South Florida (Broward, Miami-Dade, and Palm Beach counties).
 

Submitting preauthorization requests to One Homecare Solutions

Submit a preauthorization request by:

  • Faxing 1-855-441-6941
  • Calling 1-855-441-6900, Monday – Friday, 8 a.m. to 9 p.m., and Saturdays, Sundays, and federal holidays from 9 a.m. to 5 p.m. On-call after-hours support is available 24 hours, seven days a week.

Integrated Homecare Solutions reviews preauthorization requests for patients receiving services in West Florida (Hernando, Hillsborough, Pasco, Pinellas, and Polk counties); North Florida (Clay, Duval, and St. Johns counties); the Daytona area (Flagler and Volusia counties); Central Florida (Lake, Marion, Orange, Osceola, Seminole, and Sumter counties; and the Space Coast area (Brevard and Indian River counties).
 

Submitting preauthorization requests to Integrated Home Care Services

Submit a preauthorization request:

  • Through the Integrated Home Care Services online portal
  • By faxing 844-215-4265
  • By calling 844-215-4264, Monday – Friday, 8:30 a.m. to 7 p.m., and Saturdays from 8:30 a.m. to 5:30 p.m. On-call after-hours answering service is available Monday – Friday, 7 p.m. to 8:30 a.m., from 5:30 p.m. Saturday to 8 a.m. Monday, and all federal holidays, Eastern time

Integrated Home Care Services makes available through its online resource center a Referral Source Quick Reference Guide. This guide includes department phone numbers, authorization request forms, and information prescription and clinical information.

One Homecare Solutions reviews preauthorization requests for infusion therapy services for all patients with CarePlus coverage.
 

Submitting preauthorization requests to One Homecare Solutions

Submit a preauthorization request by:

  • Faxing 1-855-441-6941
  • Calling 1-855-441-6900, Monday – Friday, 8 a.m. to 9 p.m., Eastern time, and Saturdays, Sundays, and federal holidays from 9 a.m. to 5 p.m., Eastern time. On-call after-hours support is available 24 hours, seven days a week.

CarePlus Health Plans reviews MD/GT services preauthorization requests.


Submitting preauthorization requests to CarePlus

Choose from the following options to submit a request for preauthorization:

Premier Eye Care* reviews ophthalmology services preauthorization requests with CarePlus coverage. 

Submitting preauthorization requests to Premier Eye Care

Submit a preauthorization request:

  • Through its online portal (available 24 hours, seven days a week)
  • By faxing 1-800-523-3788
  • By calling 1-800-738-1889, Monday – Friday, 8 a.m. to 9 p.m., Eastern time

Health Network One* reviews preauthorization requests for patients receiving physical therapy, occupational therapy, and speech-language therapy services in West Florida (Hillsborough, Pasco, Pinellas, and Polk counties); North Florida (Clay and Duval counties); the Daytona area (Volusia County); and Central Florida (Lake, Marion, Orange, Osceola, Seminole, and Sumter counties.

Health Network One also reviews preauthorization requests for patients receiving physical therapy, occupational therapy, and speech-language therapy services for members with plan coverage for certain out-of-network services received in Puerto Rico.

Submitting preauthorization requests to Health Network One

Submit preauthorization requests:

  • Through its online portal
  • By faxing 1-855-410-0121
  • By calling 1-800-595-9631, Monday – Friday, 8:30 a.m. to 5 p.m., Eastern time

When submitting a preauthorization request (intake form), please include:

  • Clinical documentation
  • CPT code
  • Diagnosis
  • Member demographic information
  • POS
  • Requesting and referring provider information
  • Type of service

CarePlus Health Plans reviews physical therapy, occupational therapy, and speech-language therapy services preauthorization requests for patients receiving services in Flagler, Hernando, and St. Johns counties.
 

Submitting preauthorization requests to CarePlus

Choose from the following options to submit a request for preauthorization:

Health Network One* reviews preauthorization requests for patients receiving podiatry services in West Florida (Hernando, Hillsborough, Pasco, Pinellas, and Polk counties); Central Florida (Lake, Marion, Orange, Osceola, Seminole, and Sumter counties); North Florida (Clay, Duval, St. Johns counties); the Daytona area (Flagler and Volusia counties); and the Space Coast area (Brevard and Indian River counties).

Submitting preauthorization requests to Health Network One

Submit preauthorization requests:

  • Through its online portal
  • By faxing 1-866-646-1772
  • By calling 1-800-595-9631, Monday – Friday, 8:30 a.m. to 5 p.m., Eastern time

When submitting a preauthorization request (intake form), please include:

  • Clinical documentation
  • CPT code
  • Diagnosis
  • Member demographic information
  • POS
  • Requesting and referring provider information
  • Type of service

CarePlus Health Plans reviews podiatry services preauthorization requests for patients receiving services in South Florida (Broward, Miami-Dade, and Palm Beach counties).
 

Submitting preauthorization requests to CarePlus

Choose from the following options to submit a request for preauthorization:

Preauthorization for radiation oncology services is required for all patients with coverage through CarePlus, unless noted below.

Evolent Health, formerly New Century Health, reviews preauthorization requests for the following radiation oncology therapy procedures:

  • Conventional and conformal radiotherapy (2D/3D)
  • Intensity-modulated radiotherapy (IMRT)
  • Brachytherapy
  • Neutron therapy
  • Proton beam therapy
  • Stereotactic radiosurgery/stereotactic body radiation therapy (SRS/SBRT)

Evolent Health* reviews requests for any of the above oncology therapy procedures in South Florida (Broward, Miami-Dade, and Palm Beach counties).

Evolent Health will evaluate the medical necessity of the service and request necessary medical records. A physician may contact the requesting physician to discuss the preauthorization request. Submit all requests with supporting clinical documentation, including:

  • Billing type
  • Date of service
  • Patient name, height and weight, and CarePlus member ID
  • Patient diagnosis (and diagnosis code[s])
  • Provider name, location/address, phone and fax numbers, and NPI/TIN
  • Requested medication [including dose, frequency, directions for use, and /or CPT code(s)]
  • Relevant clinical information, such as:
    • Significant clinical history, including history of present illness, significant comorbidities, current medications, surgical history, key clinical exam findings and the results of conservative therapy undertaken, in detail, including duration and results.
    • Relevant current imaging reports and other key diagnostic test results
  • Site of administration
     

Submitting preauthorization requests to Evolent Health

Choose from the following options to submit a request for preauthorization:

  • Log on to Evolent Health’s website, enter your username and password, then submit your request.
    • If you need a username and password, email providertraining@newcenturyhealth.com. Use Access to Evolent Portal and your state (Florida) as the email subject line. Include your TIN, specialty, practice name, contact name, and contact phone number.
  • Fax the required information to 1-714-494-8366
  • Email efax-carepro-radonco@newcenturyhealth.com
  • Call Evolent Health’s intake coordinator department at 1-888-999-7713 and choose option 3, Monday – Friday, 8 a.m. to 8 p.m., Eastern time, Saturdays, 8 a.m. to 8 p.m., and Sundays, 9 a.m. to 5 p.m. Evolent Health is closed on federal holidays.

CarePlus Health Plans reviews preauthorization requests for the following radiation oncology therapy procedures:

  • Conventional and conformal radiotherapy (2D/3D)
  • Intensity-modulated radiotherapy (IMRT)
  • Brachytherapy
  • Neutron therapy
  • Proton beam therapy
  • Stereotactic radiosurgery/stereotactic body radiation therapy (SRS/SBRT)

CarePlus Health Plans reviews requests for any of the above oncology therapy procedures in West Florida (Hernando, Hillsborough, Pasco, Pinellas, and Polk counties), North Florida (Clay, Duval, and St. Johns counties), the Daytona area (Flagler and Volusia counties), Central Florida (Lake, Marion, Orange, Osceola, Seminole, and Sumter counties), and the Space Coast area (Brevard and Indian River counties).
 

Submitting preauthorization requests to CarePlus

Choose from the following options to submit a request for preauthorization:

Call the CarePlus Health Services Department at 1-800-201-4305, Monday – Friday, 8 a.m. to 5 p.m., Eastern time.

Health Network One* reviews urology services preauthorization requests for patients receiving procedures in South Florida (Miami-Dade County) and West Florida (Hillsborough and Pinellas counties).

Submitting preauthorization requests to Health Network One

Submit preauthorization requests:

  • Through its online portal
  • By faxing 1-866-646-1772
  • By calling 1-800-595-9631, Monday – Friday, 8:30 a.m. to 5 p.m., Eastern time

When submitting a preauthorization request (intake form), please include:

  • Clinical documentation
  • CPT code
  • Diagnosis
  • Member demographic information
  • POS
  • Requesting and referring provider information
  • Type of service

Evolent Health* reviews urology services preauthorization requests for patients receiving procedures in South Florida (Broward County).

Evolent Health will evaluate the medical necessity of the service and request necessary medical records. A physician may contact the requesting physician to discuss the preauthorization request. Submit all requests with supporting clinical documentation, including:

  • Patient name, CarePlus member ID, and physician name
  • Patient diagnosis
  • Relevant clinical information, such as:
    • Significant clinical history, including history of present illness, significant comorbidities, current medications, surgical history, key clinical exam findings and the results of conservative therapy undertaken, in detail, including duration and results.
    • Relevant current imaging reports and other key diagnostic test results
       

Submitting preauthorization requests to Evolent Health

Choose from the following options to submit a request for preauthorization:

  • Log on to Evolent Health’s website, enter your username and password, then submit your request.
    • If you need a username and password, email providertraining@newcenturyhealth.com. Use Access to Evolent Portal and your state (Florida) as the email subject line. Include your TIN, specialty, practice name, contact name, and contact phone number.       
  • Call Evolent Health’s intake coordinator department at 1-888-999-7713, Monday – Friday, 8 a.m. to 8 p.m., Eastern time.
  • Fax your request for preauthorization to 714-582-7547.

CarePlus Health Plans reviews urology service preauthorization requests for patients receiving services in Hernando, Palm Beach, Pasco, and Polk counties and in North Florida (Clay, Duval, and St. Johns counties), the Daytona area (Flagler and Volusia counties), Central Florida (Lake, Marion, Orange, Osceola, Seminole, and Sumter counties), and the Space Coast area (Brevard and Indian River counties).
 

Submitting preauthorization requests to CarePlus

Choose from the following options to submit a request for preauthorization:

Call the CarePlus Health Services Department at 1-800-201-4305, Monday – Friday, 8 a.m. to 5 p.m., Eastern time.

  • Documents. Illusration.

    Preauthorization and notification lists
     

    View documents that list services and medications for which preauthorization may be required for your patients with coverage through CarePlus.

    Preauthorization and notification lists

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*The full list of preauthorization requirements applies to your patients with CarePlus MA HMO coverage. Physicians and other healthcare providers who are affiliated with an independent practice association (IPA) or value-based network are subject to the PAL and should refer to their IPA or value-based network for guidance on processing preauthorization requests.

 

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Last Updated:

07/25/2024