RADMD | Presbyterian Health Plan

Welcome to the Presbyterian Health Plan page. The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent (formerly National Imaging Associates, Inc.) is responsible for. 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 any questions about our programs, please contact your dedicated Evolent Provider Relations Manager, Seth Cohen.

MEDICARE plans: Effective 8/5/2024, peer-to-peer discussions must be performed before a final determination has been made on the request. Medicare re-opens are only allowed if the request complies with the CMS definition of a re-open. Providers will continue to have the option to submit an appeal utilizing the health plan’s process.

Effective January 1, 2025, Evolent will no longer service Presbyterian Health Plan's Advanced Imaging Prior Authorization requests and reviews for all product lines. Please refer to the number on the back of the member's insurance card for services.

Advanced Imaging Program

For access to our Advanced Imaging tip sheets/checklists, click here.

Cardiac Program

For access to our Cardiac tip sheets/checklists, click here.

Musculoskeletal Program

For access to our Musculoskeletal tip sheets/checklists, click here.

Prior Authorization Form

Prior Authorization Form

Conservative Treatment Forms

For access to our conservative treatment forms, click here.

Clinical Guidelines

Clinical Guidelines
Refer to the Utilization Review Matrix document to view specific codes managed by Evolent.

Presbyterian Health Plan