Priority Health: As health care evolves, we want to continue to partner in the best ways possible with you, our provider network. We evaluated our management of spine services and will retire our Spine Center of Excellence (SCOE) program on Jan. 1, 2022.
We’re moving away from the physical medicine and rehabilitation (PM&R) requirement in our SCOE program. Instead, we’ll use prior authorization focused on nationally recognized criteria developed by InterQual® to manage spine services.
We previously required prior authorization for 79 spine services in eviCore, in GuidingCare only 58 spine services will require prior authorization.
What you need to know
Spine services will transition to InterQual in January 2022. You will no longer need to refer patients to a physiatrist prior to spine surgeries. You’ll need to request authorization through our Request an Auth button in prism. Once you enter your procedure code our Auth request tool will guide you to GuidingCare or tell you an authorization isn’t need for your service.
You can also visit our website for a complete list of spine services requiring authorization in 2022.