We understand that calling in prior authorization requests (also known as precertification requests) can be time-consuming. That’s why we have created a simple form that can be submitted by fax.

As a time-saving alternative to calling in and potentially waiting on hold, the Inpatient Prior Authorization Form can be used immediately for all inpatient prior authorization requests. After submitting the completed form, you will receive a response via fax (unless state mandate or law requires another means of communication). 

Checking status online

Registered users can also check the status of prior authorization requests via the secure provider portal at Provider.Evernorth.com. Registered users can also:

• Verify patient eligibility and benefits.
• View claim status and remittance reports.
• Enroll and manage electronic funds transfer.
• Make demographic/directory profile updates.
• Appeal a prior authorization decision.

Not registered yet? Register today! Portal registration is easy and only takes a few minutes.

Appealing a decision

Providers can appeal prior authorization decisions that result in adverse determinations (e.g., coverage denial). Appeals can be initiated via the provider portal at Provider.Evernorth.com for registered users with access to patient search and precertification website entitlements. 

This Precertification Decision Appeals Online Quick Reference Guide details the steps for submitting appeal decisions and checking their status using the provider portal.

Finding the form

The Inpatient Prior Authorization Form can be found in the Forms Center of Provider.Evernorth.com and includes instructions on how to complete and submit it.

If you have questions about submitting an inpatient prior authorization request by fax, please email InpatientBH@Evernorth.com.