Referrals & authorizations
Learn which services need prior authorizations, which services are not covered, and which are not medically necessary.
EOCCO Medical Necessity Criteria
- Abdominoplasty - Panniculectomy
- Aduhelm
- Air Ambulance
- Anesthesia for Routine Endoscopic Procedures
- Balloon Dilation of Eustachian Tube
- Corneal collagen cross-linking (CXL)
- Hydrogen Breath Testing
- Intravitreal Avastin
- Mobile Outpatient Cardiac Telemetry (MOCT)
- Push-Rim.Activated.Power.Assist.Device
- Serum Anitbodies for Diagnosis of Inflammatory Bowel Disease
- Skin & Tissue Substitutes
- Surgical Treatment for Achalasia
- Therapeutic Drug Monitoring
- Urinary Incontinence
- Vagus Nerve Stimulation (VNS)
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 EPSDT Prior Authorization List
- 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 Clincal Guidelines
- Behavioral Health Clinical Guidelines
Forms
Medical
- Case Management Referral Form
- Transition of Care Form
- Referral/Authorization - for all EOCCO Counties
- Referral/Authorization - for members in Morrow and Umatilla Counties through 09/30/2023
- 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
