For faster, self-service submit prior authorization requests using the Jiva Provider Portal for online admission, concurrent review, and discharge prior authorization. The portal is available 24/7 to receive electronic submissions.
Jiva Provider Portal
Provider Support: 855-759-9700 Monday through Saturday, 7:00 a.m. to 6:00 p.m. ET, except on Alliance company holidays
For out-of-network provider authorization request submissions and in-network provider authorization request submissions (not required if submitted through Jiva Provider Portal), complete the Prior Authorization Request form, attach supporting clinical information, and submit as follows:
Fax: 919-651-8691
Email: [email protected] (for authorization requests for both out-of-network and in-network providers)
Alliance Vendor Prior Authorization Submissions
Alliance utilizes the following utilization management vendors for select service lines:
Navitus: Pharmacy benefits manager
Provider Portal
Access pharmacy guidance for providers
Northwood: Durable medical equipment (DME)
Provider Portal
Fax: 877-552-6551
Avesis: Vision services
Provider Portal
Fax: 855-591-3566
ModivCare: Non-emergent medical transportation (NEMT)
Portal login
EviCore: Radiology, cardiology, laboratory, musculoskeletal and radiation oncology services
EviCore Provider Portal
EviCore Provider Portal Job Aid
Phone: 888-444-6182
Fax (radiology/cardiology/radiation therapy/pain/spine/joint): 800-540-2406
Fax (lab): 844-545-9213
Procedure Code Lookup Tool
Before submitting your request, verify the service you are providing requires prior authorization by using the Procedure Code Lookup Tool. The list of services requiring prior authorization is subject to change.
North Carolina Medicaid Prior Authorization Request Forms and Attachments
Forms that should be used to submit or accompany a PA request. Missing or incomplete forms may delay your prior authorization request.
Referrals
Alliance Health does not require referrals for services. Members eligible to receive covered services from an Indian Health Coverage Program (IHCP) have direct access to services provided by the IHCP without referral or prior authorization.
Forms that should be used to submit or accompany a PA request. Missing or incomplete forms may delay your prior authorization request.
