Av-Med, Prior Authorization

Av-Med, prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• AvMed directs providers to its Authorization and Referral Tool (AART) in the provider portal as the preferred submission method. The current provider tools page says effective 1/1/26, authorization requests will be via Availity. Urgent and emergent requests may still be submitted through the provider portal, and may also be handled telephonically or by fax. Some services are carved out to vendors such as eviCore for radiology. Requirements vary by plan and service.
• Authorization requirements vary by line of business, specialty, and location of service.
• Radiology authorizations for all AvMed members are overseen by eviCore for in-office and outpatient settings.
• The provider tools page indicates a portal transition and effective 1/1/26 authorization workflow change to Availity; operational workflows may differ by date of service.
• The source materials do not provide a single universal list of all codes requiring authorization.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3
• Verification resource 4

How to submit prior authorization requests

• AART through the provider portal

• Availity (effective 1/1/26 per provider tools page)

• Fax

• Telephone for urgent/emergent requests

• Vendor-directed submission for carved-out services such as eviCore radiology

• Submission resource 1

• Submission resource 2

Information commonly required

• Authorization request form completed legibly and completely
• Supporting clinical information as required by the service
• For some requests, medical records or documentation may be needed
• Plan-specific referral/authorization details where applicable

Turnaround notes and caveats

• Routine requests will be processed within 10 calendar days per the provider reference guide
• Urgent/emergent requests may be handled telephonically or by fax
• Some services require prior authorization based on procedure code and plan type
• Authorization requirements vary by line of business, specialty, and location of service.
• Radiology authorizations for all AvMed members are overseen by eviCore for in-office and outpatient settings.
• The provider tools page indicates a portal transition and effective 1/1/26 authorization workflow change to Availity; operational workflows may differ by date of service.
• The source materials do not provide a single universal list of all codes requiring authorization.

Provider resources

• Providers landing page (official)
• Provider tools (official)
• Provider portal (official)
• Prior authorization page (official)
• Provider reference guide (2025) (official)
• Physician and facility reference guide (official)

Sources