PA Health & Wellness

Welcome to the PA Health & Wellness 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 PA Health and Wellness Medicaid and Exchange members. To review SoC Guidelines refer to the Clinical Guidelines section on this page or click here.
Advanced Imaging Program
- Frequently Asked Questions
- Scope of Service
- Utilization Review Matrix - Medicaid - 2026
- Utilization Review Matrix - Medicare - 2026
- Provider Education Presentation
For access to our Advanced Imaging tip sheets/checklists, click here.
Musculoskeletal Program
- Frequently Asked Questions
- Utilization Review Matrix (Hip, Knee and Shoulder) - 2026
- Utilization Review Matrix (Spine Surgery) - 2026
- Provider Education Presentation
- MSK Surgery Requests with SoC Workflow Presentation- Effective 11.03.2026 for Medicaid and Exchange
For access to our Musculoskeletal tip sheets/checklists, click here.
Interventional Pain Management Program
For access to our Interventional Pain Management 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.

