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Oregon: New pre-approval requirements


Our Enhanced Clinical Review program with eviCore healthcare requires authorization for certain procedures. As we previously communicated in a direct mailing, this program became effective for Oregon on August 1, 2022. It affects Oregon members in our commercial Aetna® products.


Services that require pre-approval


  • High-tech outpatient diagnostic imaging procedures such as MRI/MRA, nuclear cardiology, and PET scan and CT scan, including CTA
  • Nonemergent outpatient stress echocardiography
  • Nonemergent outpatient diagnostic left and right heart catheterization
  • Insertion, removal and upgrade of elective implantable cardioverter defibrillator, cardiac resynchronization therapy defibrillator and implantable pacemaker
  • Polysomnography (attended sleep studies)
  • Interventional pain management
  • Radiation therapy services — these include complex and 3D conformal; Stereotactic Radiosurgery (SRS)/Stereotactic Body Radiation Therapy (SBRT); brachytherapy; hyperthermia; Intensity-Modulated Radiation Therapy (IMRT)/Image Guided Radiation Therapy (IGRT); proton beam therapy; neutron beam therapy; and radiopharmaceuticals

For a complete list of procedures that need authorization, go to


Submitting authorization requests


Before members receive services, eviCore healthcare’s board-certified physicians will review authorization requests for medical necessity. For you to get paid for services, you must send authorization requests before providing those services.


If treatment started before August 1, 2022, and you haven’t already called Aetna, contact eviCore healthcare to request continuity-of-care authorization. This will allow claims for dates of service after August 1, 2022, to be considered.


Radiation therapy services are reviewed in accordance with nationally recognized clinical and billing guidelines of the American College of Radiation Oncology, American Society of Radiation Oncology, other recognized medical societies, and Aetna Clinical Policy Bulletins (CPBs).


Asking eviCore healthcare for approval


Note that fax request forms are available online.


  • Send a fax to 1-800-540-2406 for all radiology, cardiology and radiation therapy requests.
  • Send a fax to 1-866-999-3510 for sleep requests.
  • Send a fax to 1-855-774-1319 for interventional pain requests.

Urgent requests


If a member needs services in less than 48 hours due to medically urgent conditions, please call eviCore healthcare for a fast review. Tell the representative that the request is for urgent care.


Important information to know


  • We recommend that ordering physicians get authorizations and share the approval numbers with the facility performing the procedure when it is scheduled.
  • eviCore healthcare will fax their approval decision to the ordering physicians and requested facilities.
  • Approvals have authorization numbers, and one or more CPT codes specific to the approved services.
  • If the service you ask for differs from what eviCore healthcare approves, the facility must contact eviCore healthcare for review and approval before submitting claims.
  • If you perform services without approval, we may deny payment. Please don’t ask members for payment, as outlined in your agreement with us.
  • We’ll determine coverage under the applicable policy in accordance with the policy’s terms and conditions and with our policies and procedures.



If you have questions, call the Provider Contact Center at 1-888 MD AETNA (1-888-632-3862) (TTY: 711).


You can also see eviCore healthcare’s criteria and get request forms at

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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