Provider Alert: Updated Evolent Prior Authorization Requirements

Fecha: 02/03/26

Ambetter Health partners with Evolent Specialty Services to manage utilization management for certain prior authorization requirements. As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, Ambetter Health wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes and facilitate timely access to appropriate, high-quality care.

Code changes will be effective on April 1, 2026. Code changes can be found below.

The following Radiology and Diagnostic Cardiology (RBM) codes have been removed from the Evolent’s Utilization Review Matrix and no longer require prior authorization for Marketplace.

The following Cardiology codes have been removed from the Evolent’s Utilization Review Matrix and no longer require prior authorization for Marketplace.

For questions or concerns, contact your provider engagement account manager in your area or call Provider Services at 1-833-919-3213, Monday – Friday 7 a.m. to 7 p.m. CT. Thank you for your partnership in serving our members.