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December 2016 Texas Medicaid Provider Procedures Manual

Section 5: Fee‑for‑Service Prior Authorizations : 5.5 Prior Authorization Submission Methods : 5.5.4 Radiology Prior Authorizations Through eviCore : Retroactive Authorization Requests
Retroactive authorization requests for outpatient diagnostic computed tomography (CT), magnetic resonance (MR), positron emission tomography (PET) and cardiac nuclear imaging services for Texas Medicaid fee-for-service clients must be submitted online to eviCore. The retroactive authorizations requests must be submitted to eviCore no later than 14 calendar days after the day on which the study was completed, regardless of the method of submission. If the retroactive authorization request is submitted after the allotted time, the authorization request will not be processed. Providers can refer to the TMHP website for eviCore’s contact information and methods of submission.

Texas Medicaid & Healthcare Partnership
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