Buckeye Health Plan

Welcome to the Buckeye Health Plan 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 3, 2026, Evolent will perform Site of Care (SoC) review for applicable musculoskeletal (MSK) surgeries for Buckeye Health Plan Medicaid members. To review SoC Guidelines refer to the Clinical Guidelines section on this page or click here.
Effective January 1, 2026, Buckeye Community Health Plan is adding Integrated Dual-Eligible Special Needs Plans (D-SNP/D-SNP-POS) to their current programs with Evolent.
Advanced Imaging Program
- Frequently Asked Questions
- Utilization Review Matrix - Medicaid - 2026 (Effective 04.01.2026)
- Utilization Review Matrix - Medicaid - 2026 (01.01.2026 - 03.31.2026)
- Utilization Review Matrix - Medicare - 2026 (Effective 04.01.2026)
- Utilization Review Matrix - Medicare - 2026 (01.01.2026 - 03.31.2026)
- Provider Education Presentation
For access to our Advanced Imaging tip sheets/checklists, click here.
Cardiology Program
For access to our Cardiac tip sheets/checklists, click here.
Musculoskeletal Program
- Frequently Asked Questions
- Utilization Review Matrix (Hip, Knee, Shoulder Surgery) - 2026
- Utilization Review Matrix (Spine Surgery) - 2026
- Provider Education Presentation
- MSK Surgery Requests with SoC Workflow Presentation- Effective 11.03.2026
For access to our Musculoskeletal tip sheets/checklists, 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
- MSK Site of Care (SoC) Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by Evolent.

