What is EviCore? Understanding Premera’s Outpatient Rehabilitation Management Program
On July 1, 2025, the University of èßäÊÓƵ implemented EviCore on all UA Choice Medical
Plans. EviCore is an outpatient rehabilitation management program that provides prior-authorization to determine medical necessity for physical, occupational, and massage therapy services.
Who is EviCore?
EviCore provides prior-authorization for physical, occupational, and massage therapy services. They review the plan of care submitted by a provider to ensure that members are receiving the right care for their condition and are avoiding unnecessary treatments and costs. They are rated by the which accredits health plans based on quality measures to ensure standards for both quality and care are met.
How does a member interact with EviCore?
Members do not interact with EviCore on their own. Instead, they meet with their provider for an initial evaluation. At this initial evaluation, the provider will determine a plan of care and submit it directly to EviCore for review and authorization.
How does a provider interact with EviCore?
Providers submit their plan of care for prior authorization directly to EviCore after their initial evaluation with their patient. The prior authorization request can be submitted to EviCore via EviCore's online portal or via fax. The online portal provides the fastest turn around time. Any provider who needs to submit a prior authorization request to EviCore can register for an EviCore account, if they do not already have one, and submit the request via the online portal.
What information does the Prior Authorization contain?
The prior authorization submitted to EviCore by the provider will include the patient’s clinical information, the plan of care as determined by the initial evaluation date, and the treatment time frame.
How are prior authorization requests reviewed and processed by EviCore?
Once received, EviCore will review the plan of care for medical necessity. The review is completed with evidence based clinical guidelines. EviCore does not use AI to determine medical necessity and does not use AI for any of the services they provide to Premera . EviCore is also paid per review, not whether or not the plan of care was approved or denied. If the plan of care was submitted via the EviCore portal, the authorization is typically processed withing the same day of submission. If the plan of care was submitted via fax, the authorization can take two-five business days to process. After review, the provider is given notice of all approved prior authorization requests along with the date range the approval is authorized for. The provider then works with their patient to schedule and proceed according to their approved plan of care. When a plan of care is determined not medically necessary, the authorization is denied, and both the provider and the patient receive a notification with an explanation of the denial along with the rights to appeal.
Questions?
As always, if you have any questions on your benefits, don't hesitate to reach out to the benefits team. Additionally, you can work with TouchCare for personalized health care assistance by calling them at 1-866-486-8242, emailing at assist@touchcare.com or submitting a request via . Premera's customer service is also available by calling the number on the back of your Premera ID card.
Emailed via benefits newsletter on 9/9/2025.
Published via UA News on 9/5/2025.
Contact Benefits: (907) 450-8242 | ua-benefits@alaska.edu | schedule one-on-one time