Evernorth^® Behavioral Health (Evernorth) is committed to supporting providers with tools that enhance efficiency and reduce administrative burden. We understand that calling in residential prior authorization requests can be time-consuming, so we are pleased to offer a new option that streamlines the process with a faxable form.

Available submission options

Fax submission (new)

Effective immediately, you may submit residential prior authorization requests using the new Residential Prior Authorization Request Form. To submit a request:

• Fax all required information to 833.213.9320.
• Complete the form in its entirety.
• Include additional clinical information outlined at the bottom of page three of the form to assist us with processing your request.

Once processed, you will receive a decision notification by fax or phone.

Phone submission

If preferred, you may continue to submit requests with clinical information by phone at 800.926.2273.

To access the form

The new form is available at Provider.Evernorth.com > Forms Center > Residential Prior Authorization Request Form. It includes helpful tips to make completing and submitting the form as easy as possible.

We encourage you to share this form with your colleagues.

Additional information

If you have any questions about this email, please contact Provider Services at 800.926.2273.