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Please only send exam request form, do not send more than one request at a time.

Colorado Region Radiology Request form*
Send in this form to request radiology procedures.

Colorado Region X-Ray Order form*
Send in this form to request X-Ray Procedures.


Kaiser Permanente has contracted with eviCore to manage outpatient radiology services for Southern and Northern Colorado Members. Through this partnership, eviCore and Kaiser Permanente will work together to strategically identify opportunities to enhance quality by insuring appropriate use of radiology services for each member’s condition.

Services that require authorization in an outpatient setting (freestanding imaging center including stationary as well as mobile, outpatient hospital, and physician offices) include:

  • CT/CTA
  • Nuclear Medicine
  • Nuclear Cardiology
  • PET
  • Services that will not require pre-authorization are those provided in the inpatient hospital, emergency room, observations unit, and urgent care centers.
  • The ordering physician and/or designee are responsible for obtaining authorizations via phone, 1-888-835-1712 or web A designee may be a member of the physician office staff.
  • Rendering Physicians can obtain validation of authorization by phone 1-888-835-1712 or web
  • Once authorized, eviCore will contact the member to schedule the appointment.

Please refer to eviCore FAQ's for additional details*

All providers are encourage to setup access through eviCore web portal. The web portal allows users to manage their account and create/inquire on authorizations 24/7.

Log onto, and click on register under ordering provider login section.

Please refer to eviCore Web Utilization for additional details*