As the chief medical officer of eviCore healthcare, a medical benefits management organization within Evernorth Health Services, Dr. Eric Gratias and his team work to ensure . Contact your designated Independence Provider Network Services (PNS) team contact. Do you offer a mandatory prior authorization program for all sleep studies? Phone Number 1.800.646.0418 x20136 Email portal.support@evicore.com Affiliations Stay Updated With Our Provider Newsletter Your email address Website Feedback Thank you for using eviCore's website today! Which EHRs does eviCores intelliPath ePA support? Ethics & Compliance | Note: Most out-of-network services require utilization management review. Contact Us; Search. EmblemHealth Reduces Preauthoriz . Providers can call toll-free at 1-855-252-1117 between 6 a.m. to 6 p.m. (central time) Monday through Friday and 9 a.m. - noon Saturday, Sunday and legal holidays. Learn more about the life-interrupting issue of back pain, and the long-term benefits of saving surgery for a last resort. Prior Authorizations. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Beginning Friday, December 18th at 5:00pm EST, you You can fax your authorization request to 1-800-217-9345. In this weeks podcast, Dr. Torelli and Liz Avila discuss why its important for all patients to learn more about their care. What claims are subject to claims review? eviCore supports Choosing Wisely (www.choosingwisely.org), an initiative maintained by the American Board of Internal Medicine (ABIM) Foundation and many national physician organizations, to reduce the overuse of diagnostic tests that are of marginal or no value, or whose risks are greater than their benefits. Tune into our new Auth the Cuff podcast episode with guest Dr. David-Park, Sr. Medical Director PAC/DME, for a great conversation on over utilization, a real-life patient example, and more. Thank you for using eviCores website today! Refer to theeviCore Webexpage to register and the select the menu bar symbol located on the left-side of the webpage and select "Webex Training". This is not an all-inclusive list. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Use the Prior Authorization Crosswalk Table when you have an approved prior authorization for treating a UnitedHealthcare commercial member and need to provide an additional or different service. Create an Account. Availity provides administrative services to BCBSIL. Ethics & Compliance | Hospitals should contact CareAllies at (800) 227-9360 to obtain prior authorization. Mailing address. Copyright 2022 eviCore healthcare. Thank you for using eviCores website today! If you have any questions, call the number on the member's ID card. [{"id":39210,"versionId":6468,"title":"Highmark Post-PHE Changes","type":4,"subType":null,"childSubType":"","date":"4/7/2023","endDate":null,"additionalDate":null,"imageUrl":null,"url":null,"urlText":null,"description":"\u003cp\u003eWith the upcoming expiration of the PHE, Highmark has started the process of updating COVID-19-impacted policies and procedures. Services requiring prior authorization through eviCore are outlined below. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. All Requests: Utilize Authorization Inquiry function in NaviNet. eviCore is committed to providing an evidence-based approach that leverages our exceptional clinical and technological capabilities, powerful analytics, and sensitivity to the needs of everyone involved across the healthcare continuum. Care Management Programs Member Rights Policy | All Rights Reserved. What types of services are managed under your sleep solution? Multi-Factor Authentication (MFA) is now live on eviCores web portal! Q1: Overall, how satisfied are you with eviCores website? of authorization request(s). Available Trainings eviCore periodically will host orientation sessions for providers for various care categories. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Were still hiring for other The system can easily be made an extension of the clients existing claims workflow. Q1: Overall, how satisfied are you with eviCores website? Subject: Sign- up for eviCore Healthcare's Training for new Prior Authorization requirements! Thank you for using eviCores website today! E-Verify and IER Right to Work. Federal Employee Program (FEP ) Verify eligibility and benefits and/or check claim status for FEP members. In addition to verifying membership/coverage status and other important details,this step returns information on prior authorization requirements and utilization management vendors, if applicable. Review claim status and request claim adjustments. A prior authorization isnota guarantee of benefits or payment. Reminding and guiding patients to get the care they need. In addition, some sites may require you to agree to their terms of use and privacy policy. How will prior authorization determinations be communicated? This new site may be offered by a vendor or an independent third party. Phone - Call eviCore toll-free at 855-252-1117 . Once a prior authorization request is received and processed, the decision is communicated to the provider. %%EOF AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. How did you get my phone number/information? E-Verify and IER Right to Work. What do I do if a members eligibility is incorrect or not on file? Authorizations for HDHP, Standard and High Option members For more detailed information, including specific CPT codes that requireeviCoreprior authorization, visit theeviCore implementation siteand select the BCBSTX health plan for the applicable CPT/HCPCS code lists and physician worksheets by service. open positions so continue your job search at Cigna.com/careers. eviCore intelliPath . How does eviCore interact with providers? GHI Medicare non-City of New York. :|gx7e#FB|+9?{RX7:!m$wCrrra4Ok2gfMrTsw Medical Oncology: Call: 1 (866) 668-9250 Fax: 1 (800) 540-2406. $4d? vI By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. If you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request. Health Plans. xUn@}?SeGbWZ"%@T%!RUE}\ZCRPC }X9sf8;;wngs!%`%9y+tVpz``j&[gc; L5uL"C|@8%*i0NeeFETPr$s@?(fXf,bj)z] p)c3+$Ht^NJ)('z#jc'C&9.BaE7K\ed:2\ueD(AqupHO([itZqIuX.UvV,VW7q|U}[dEMz@T`xbSg:qbL}yb Al55&9)T9^6'PZ'CGjtt Tk[&nX^\C`=?EAy5z-WWVx/)p=]l8N/q%KDs!wfk!P! The instructions on how to submit a case and a link to the correct portal to use will be provided. reCAPTCHA is not valid; Please try again! Check eligibility and benefits for members. Terms of Use | endobj endobj Regardless of any Prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider. Box 30757 Salt Lake City, UT 84130-0757 Payer ID#: 87726 (EDI claims submission) Pharmacy As a valued user of our website, wed appreciate your feedback to help us improve your website experience. E-Verify and IER Right to Work. Click herefor the MFA registration & setup guide. 400 Buckwalter Place Blvd. What is the fastest way to do this? The site may also contain non-Medicare related information. For prior authorization requests handled by BCBSIL: There are two ways to initiate your request. In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. Q4: How can eviCore make it easier for you to use this website? Prior authorization lookup tool. reCAPTCHA is not valid; Please try again! All Rights Reserved. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Well before the pandemic, consumers were leaning towards home healthcare versus facility based care when appropriate for a number of reasons. Description. Tune into our new Auth the Cuff episode with eviCore's Dianne Doherty, Sr. If you need preauthorization, contact eviCore in one of three ways: Get immediate approval by submitting your request at www.evicore.com. The site may also contain non-Medicare related information. All Rights Reserved. <> open positions so continue your job search at Cigna.com/careers, Something went wrong.Please try again after some time, Thank you for submitting. Directory Who to Contact for Preauthorization All providers must verify member eligibility and benefits prior to rendering non-emergency services. wont be able to apply to eviCore openings. What is included in the Radiation Oncology program? wont be able to apply to eviCore openings. Q4: How can eviCore make it easier for you to use this website? hb```|7@($qFqr&kX Q8rC%xd]ZG{5LA[K;:]*${;fR4kE[zGV@EFH;!Az. I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? As a valued user of our website, we'd appreciate your feedback to help us improve your website experience. Learn more from eviCore experts Sid Govindan, MD and John Young on how eviCore is applying these technologies to evolve the prior authorization process. There is a notion of utilization management being solely focused on cost savings. \u003ca href=\"https://content.highmarkprc.com/Files/NewsletterNotices/SpecialBulletins/sb-post-phe-provider-communication.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"\u003e\u003cstrong\u003eCLICK HERE\u003c/strong\u003e \u003c/a\u003efor the details.\u003c/p\u003e","visible":false,"archive":false,"liveStatus":2}], Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (, Examples of services that may require authorization include, Potentially experimental, investigational, or cosmetic services, Select injectable drugs covered under the member's medical plan, Select Not Otherwise Classified (NOC) procedure codes, i.e., unlisted, miscellaneous, Not Otherwise Specified (NOS). eviCore.com. Privacy Policy | How does eviCore interact with Post-Acute Care patients? Check status of submitted authorizations. stream Learn more about the field of radiation oncology and how evidence-based guidelines enhance patient-centered care from Dr. Nimi Tuamokumo, eviCore Senior Medical Director and Radiation Oncologist. IMPORTANT: In the coming days, we will be migrating systems for our Q1: Overall, how satisfied are you with eviCores website? Simply visit the eviCores Providers Hub page and select the health plan and solution option for your case in the training section. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. As part of our continued effort to provide a high quality user experience while also ensuring the integrity of the information of those that we service is protected, Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. See Clinical Corner for services that require Preauthorization. You may also go directly to eviCore's self-service web portal at www.evicore.com. Copyright 2022 eviCore healthcare. In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. Q4: How can eviCore make it easier for you to use this website? You will receive a letter in the mail and your physician will receive a letter via fax communicating this information. Prior authorization requests for our Blue Cross Medicare Advantage (PPO)SM(MA PPO), Blue Cross Community Health PlansSM(BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SMmembers can be submitted to eviCore in two ways. Another part is having access to an exceptionally large volume of historical cases. Learn more about the work eviCore's Advanced Analytics R&D team does to support the business with a spotlight on an analysis on conservative therapy for low back pain. If urgent (after-hours) call 866-322-6287 , from 9 p.m. to 9 a.m., Monday through Friday. View fee schedules, policies, and guidelines. For more information about prior authorization, please review Mercy Care's Provider Manuals located under the Provider Information tab on our website. wont be able to apply to eviCore openings. Member Rights Policy | Step 1 Confirm if Prior Authorization is Required. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Digital Breast Tomosynthesis is a Hot Topic, Global Shortage of Iodinated Contrast Media, Q&A: eviCores Chief of Radiology on the Need for Evidence-Based Imaging, The 8 Most Common Inappropriately Ordered Tests and Why They're Being Denied, Check Status of Existing Prior Authorization. All Rights Reserved. Thank you for using eviCores website today! Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. What additional tools are available as add-on programs to the Radiology solution? In some instances repeat exams for condition treatment or management will require prior authorization. Behavioral health. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, CAR-T Cell Therapy & Medical Oncology Disparities, Crunching the Numbers! endobj As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. External link You are leaving this website/app (site). How does my doctor access the Specialty Drug Management solution? Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST. 1 0 obj In general, there arethreestepsprovidersshould follow. In addition, they face growing administrative burdens. Second, when requests reach a final status, the patient receives a letter indicating whether the request has been approved or denied. 560 0 obj <>/Filter/FlateDecode/ID[<8C57985C8CBDD144A535DF79903CF9DC>]/Index[539 33]/Info 538 0 R/Length 105/Prev 288900/Root 540 0 R/Size 572/Type/XRef/W[1 3 1]>>stream The reality is, most providers weren't initially trained to deliver virtual care. ** Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. PROVIDERS AREA. How does eviCore communicate with the patients provider? eviCore positions. You are leaving this website/app (site). The authorization is typically obtained by the ordering provider. reCAPTCHA is not valid; Please try again! Certain employer groups may require prior authorization or pre-notification through other vendors. 571 0 obj <>stream Refer to the Procedures that require authorization by eviCore healthcaredocument for more details. What types of radiology procedures require prior authorization? <>>>/BBox[ 0 0 576 201.59] /Matrix[ 0.125 0 0 0.35716 0 0] /Filter/FlateDecode/Length 7100>> Terms of Use | eviCore positions. Obtain prior authorizations through eviCore using one of the following methods: eviCoreperiodically will host orientation sessions for providers for various care categories. Please click here to register for an account. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. 4. Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. The table will help you determine if you can use the approved prior authorization, modify the original or request a new one. Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. The diagnostic exams requiring prior authorization generally include the following procedures*: *prior authorization of certain procedures can vary by health plan. So how do we continue to think about best practices for telehealth? This step will also help you determine if your services require prior authorization throughBCBSTXoreviCore. eviCore made it easy to complete my primary task online. Ethics & Compliance | Outpatient: 1-844-442-8012. wont be able to apply to eviCore openings. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider. As noted above, when you check eligibility and benefits, in addition to confirming if prior authorization is required, youll also be directed to the appropriate vendor, if applicable. What if the request does not meet clinical criteria? eviCores provider experience solution offers providers ongoing touchpoints that include a team dedicated to on-site visits; professional surveys; and the rigorous tracking and receiving of feedback from both providers and our clients. Prior authorization of a service is not a guarantee of payment of benefits. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. Prior authorization status can be viewed on demand via the eviCore portal at www.evicore.com or by calling eviCore at 866-220-3071. eviCore currently maintains a nationwide advanced imaging network, featuring contracts with providers of imaging services in specific/predetermined locationsand as well as freestanding facilities. Fax an eviCore healthcare request form (available online) to 1-888-693-3210 Also, to ease the administrative burden of requiring prior authorization of OB Ultrasound studies, providers may batch service requests for up to 12 weeks and cases may be reviewed retrospectively for up to 3 business days following the date of service. Sign in Learn more about electronic authorization Pre-authorization lists Commercial Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of Texas (BCBSTX) has contracted witheviCore healthcare (eviCore)*to provide certain utilization management prior authorization services for our government programs. we will be implementing changes to evicore.com in the near future. Use your practice management system or vendor: Health Care Request and Response (ANSI 278) - Contact your Electronic Data Interchange (EDI) or Practice Management System vendor. %PDF-1.6 % The eviCore intelliPath. Please click here to register for an account. Additional information on authorizations can be found in Chapter 5 (Care & Quality Management) of the Highmark Provider Manual. Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. Verify Member's ID Card At each visit, the oce should ask to see the member's ID card to verify eligibility and to collect the appropriate copayment. Based on the feedback we receive, we continuously upgrade our operational efficiencies through ongoing addition of Web enhancements that improve the user experience and offeradditional support to our providers. Please be reminded, effective June 1, 2023, AmeriHealth Caritas Florida will require prior authorization from eviCore Healthcare for the covered health care services listed below: Why is eviCore providing intelliPath ePA free of charge for eviCore-managed lives? . For government programs prior authorization requests handled by eviCore healthcare (eviCore): To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers Were still hiring for other (This information should not be relied on as authorization for health care services and is not a guarantee of payment.). Some procedures may also receive instant approval. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status As a valued user of our website, wed appreciate your feedback to help us improve your website experience. "eviCore has over 1,100 doctors, therapists and nurses from a variety of specialties. Copyright 2022 eviCore healthcare. How does a computer make healthcare decisions? Contact J&B at 1-888-896-6233 or . Please click here to register for an account. open positions so continue your job search at Cigna.com/careers. We start off todays podcast talking about echocardiograms, one of the coolest tests ever. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Eligibility Verification Providers should verify member eligibility prior to requesting/providing services. Musculoskeletal (eviCore): 800-540-2406 Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. please email the case number and request to: reqcriteria@eviCore.com. View fee schedules, policies, and guidelines. Refer to the March 30, 2023, provider notice (PDF) for more information and to register for training based on your physicians specialty.