BlueChoice HealthPlan

Welcome to the BlueChoice HealthPlan page. The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent is responsible for managing. Additional process-specific training tools and modules can be found via links on the Resources tab at the top of the screen.
If you have questions about our programs, please contact Evolent at [email protected].
Program Updates:
Effective November 1, 2026, Evolent will manage PA requests for joint (hip, knee, shoulder) surgeries for BlueChoice® Commercial fully insured, ASO and Healthy Blue℠ (Medicaid). Providers can review updated Evolent resources, including the MSK - Hip, knee and shoulder Utilization Review Matrix and Evolent Scope of Service below.
Advanced Imaging Program
- Frequently Asked Questions
- Provider Education Presentation
- Evolent Scope of Service
- Utilization Review Matrix - 2026 (Effective 07.01.2026)
- Utilization Review Matrix - 2026 (Effective 01.01.2026 - 06.30.2026)
For access to our Advanced Imaging tip sheets/checklists, click here.
Interventional Pain Management Program
For access to our Interventional Pain Management tip sheets/checklists, click here.
Musculoskeletal Program
- Provider Education Presentation
- Evolent Scope of Service - (Effective 11.1.2026)
- Evolent Scope of Service
- Utilization Review Matrix (MSK - Hip, Knee, Shoulder Surgery) - 2026 - Commercial, Exchange and Medicaid (Healthy Blue) (Effective 11.01.2026)
- Utilization Review Matrix (MSK - Hip, Knee, Shoulder Surgery) - 2026 - Exchange (Effective 07.01.2026-10.31.2026)
- Utilization Review Matrix (MSK - Spine Surgery) - 2026
For access to our Musculoskeletal tip sheets/checklists, click here.
Radiation Oncology Program
For access to our Radiation Oncology checklists/clinical guidelines/coding standards, click here.
Peer-to-Peer Process
For access to our peer-to-peer process, click here.
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
Low Dose Chest CT History Form
Clinical Guidelines
- Clinical Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by Evolent.

