Referrals & authorizations
Learn which services need prior authorizations, which services are not covered, and which are not medically necessary.
New! Submit your prior authorization request electronically
EOCCO Medical Necessity Criteria
- Air Ambulance
- Allergy testing-blood
- Anesthesia for Routine Endoscopic Procedures
- Balloon Dilation of Eustachian Tube
- Intravitreal Avastin
- Knee Cartilage Transplants
- Mobile Outpatient Cardiac Telemetry (MOCT)
- Push-Rim.Activated.Power.Assist.Device
- Serum Anitbodies for Diagnosis of Inflammatory Bowel Disease
- Skin & Tissue Substitutes
- Therapeutic Drug Monitoring
- Vagus Nerve Stimulation (VNS)
- Vitamin D testing
Guidelines
The following tools are EOCCO’s referral and authorization guidelines and instructions. They can help you understand prior authorization request requirements and other medical services that do not require authorization.
- Prior authorization guidelines and instructions
- EOCCO injectable PA list
- EOCCO prior authorization list
- EOCCO Prior Authorization Ages Under 21
- EOCCO Site of Care Policy
- EOCCO Site of Care FAQ
- eviCore Advanced Imaging PA
- eviCore Cardiology PA
- New requirements for elective surgeries
- Medicaid Telemedicine and Telehealth Overview and Guidelines (June 4, 2020)
- eviCore website
- Covered and Non-Covered Behavioral Health Services List
Clinical Practice Guidelines
- EOCCO Clinical Practice Guidelines
- Advantage Dental Clinical Guidelines
- ODS Community Dental Clinical Guidelines
- Behavioral Health Clinical Guidelines
Clinical Practice Guidelines Policy
Forms
Medical
- Case Management Referral Form
- Transition of Care Form
- Referral/Authorization - for all EOCCO Counties
- Cribs for Kids© Program Referral Form
- EOCCO Flexible Services Request Form (Health Related Services)
- Multidisciplinary team flyer
- Multidisciplinary team referral form FAQ
- Multidisciplinary Team Referral Form
Behavioral Health
- Behavioral Health Authorization Form
- Behavioral Health Care Management Referral Form
- Psychological and Neuropsychological Evaluation Behavioral Health Authorization Form
- Out of Network (OON) Provider Behavioral Health Authorization Form
