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. Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. Copyright 2022 eviCore healthcare. Watch or listen to our new Auth the Cuff #podcast with Aaron Hackman and Lauren Kortmeyer, BSN, RN, from the radiology department at UCHealth, where we discuss the difference inclusive, conditionally-based guidelines have made for their nurses, clinicians, and patients. Please complete the Dental Specialty Referral Request Form and fax to 480-350-2217, email to: HCHdentaldeptHCA@azblue.com, or mail to: BCBSAZ Health Choice, Inc. Attn: Dental Prior Authorization. Continue to Authorization Lookup Login Log In Forgot User ID? 1 0 obj Q4: How can eviCore make it easier for you to use this website? IMPORTANT: In the coming days, we will be migrating systems for our Call 1 (800) 88CIGNA (882-4462). The associated preauthorization forms can be found here. Online - The eviCore Web Portal is available 24x7. Additional information about the programs and links to prior authorization codes are available under Care Management Programs in the left website menu. Our hosts Dr. Torelli and Liz Avila are here to explain why. View fee schedules, policies, and guidelines. They are discussing how recent technology innovations will be utilized to better partner with providers as we work to redefine healthcare and drive value to patients. Report Fraud & Abuse | Q1: Overall, how satisfied are you with eviCores website? To viewrequirements summaries andprocedure code lists, refer to theSupport Materials (Commercial)andSupport Materials (Government Programs)pages. EmblemHealth Preauthorization List. In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. Please click here to register for an account. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. %PDF-1.6 % MEDICAL POLICIES What additional tools are available as add-on programs to the Radiology solution? Register Now Portal Login Insights Blog eviCore Colorectal Screening Program 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. In some instances repeat exams for condition treatment or management will require prior authorization. Specifically designed with the size and scale to address the complexity of our healthcare system today and tomorrow, eviCore is committed to advancing healthcare management through evidence-based medicine. Specialized therapies such as chiropractic, acupuncture, and physical therapy are cost effective, and can provide improved outcomes for chronic pain patients. Ethics & Compliance | Clinical guidelines are becoming increasingly necessary to get proper testing, but not all guidelines are created equal. 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. It speaks to the rapidly evolving healthcare industry, especially the increasing role of prior authorization and how providers can more effectively navigate it. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. The associated preauthorization forms can be found, Gastric Surgery/Therapy/Durable Medical Equipment/Outpatient Procedures: 888-236-6321, Home Health/Home Infusion Therapy/Hospice: 888-567-5703, WholeHealth Networks, Inc. (WHN), a subsidiary of Tivity Health Support, LLC.,for, View the List of Procedures/DME Requiring Authorization, View the List of FEP Standard and Basic Procedures/DME Requiring Prior Approval, View the List of FEP Blue Focus Procedures/DME Requiring Prior Approval, Non-Urgent Inpatient Authorization Submission, Urgent Inpatient Authorization Submission, Auth Automation Hub Frequently Asked Questions, Advanced Imaging and Cardiology Services Program, Musculoskeletal Surgery and Interventional Pain Management Services Prior Authorization Program, Post-Acute Care for Medicare Advantage members, Inpatient admissions (e.g., acute inpatient, skilled nursing facility, rehabilitation hospital, behavioral health facility, long-term acute care facility), Speech Therapy services, including those provided to Medicare Advantage members. Q1: Overall, how satisfied are you with eviCores website? open positions so continue your job search at Cigna.com/careers, Something went wrong.Please try again after some time, Thank you for submitting. eviCore positions. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * eviCore positions. Our goal is to provide high-quality, cost-effective sleep management services to customers who are covered under benefit plans that include precertification of outpatient procedures. Outpatient: 1-844-442-8012. Emergency services are an exception. Portal:The preferred - and fastest - method to submit preauthorization requests and receive approvals isNaviNet. We offer providers ongoing touch-pointsthat include a team dedicated to on-site visits; professional surveys; and the rigorous tracking and receiving of feedback from both providers and our clients. The provider is responsible for verification of member eligibility and covered benefits. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). In practice, utilization management plays a large role in patient safety and empowerment. Terms of Use | Positron emission tomography computed tomography (PET-CT), Computed tomography angiography (CTA) scans, Non-OB ultrasound including head & neck, pediatric, breast, abdomen & retroperitoneum, extremity, arterial & venous, and gynecological, OB ultrasound including obstetrical ultrasounds and fetal echocardiography, eviCore currently maintains a nationwide advanced imaging network, featuring contracts with providers of imaging services in specific/predetermined locations. The table will help you determine if you can use the approved prior authorization, modify the original or request a new one. 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, PROVIDERS AREA. Why didn't you call me the last time I had a procedure? eviCores Radiology solution delivers cost savings and improved patient outcomes by ensuring health plan members receive the appropriate test or treatment necessary for their individual case presentation or condition. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. The Member Customer Care Center is open Monday-Friday, 8 am to 6 pm (ET). Prior Authorization Automation. 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. One option is Adobe Reader which has a built-in reader. IMPORTANT: In the coming days, we will be migrating systems for our You can fax your authorization request to 1-800-217-9345. Finally, eviCore manages select cardiology and radiology services for dates of service prior to Oct. 1, 2018, including postservice requests. This new site may be offered by a vendor or an independent third party. we will be implementing changes to evicore.com in the near future. GHI Medicare non-City of New York. To check on the status of an authorization, please visit our provider secure web portal. Ethics & Compliance | What if the request does not meet clinical criteria? For Prior Authorization requests, use one of the following: CoverMyMeds: Website: CoverMyMeds.com (Preferred) Call: 1 (877) 813-5595 reCAPTCHA is not valid; Please try again! Pharmacy Prior Authorization eviCore Medical Oncology Drug List The "Live Sessions" page will display. <> eviCore has one the largest Cardiology Prior Authorization program in the country, providing you a chance to impact clinical change on a nationwide scale while supporting patients in all U.S. time zones ; Career opportunities and growth. 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 Effective 10/13/2017 - 12/31/2020. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. Beginning Friday, December 18th at 5:00pm EST, you of authorization request(s). Radiation Therapy: Call: 1 (866) 686-4452 . The eviCore intelliPathSM electronic prior authorization solution (intelliPath ePA) unifies the entire PA processfrom submission to decisioninto a single application integrated with the patients electronic health record (EHR). Refer to the March 30, 2023, provider notice (PDF) for more information and to register for training based on your physicians specialty. Member Rights Policy | Review claim status and request claim adjustments. Thank you for using eviCores website today! 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 . So how do we continue to think about best practices for telehealth? Call Center: eviCore's is available from 7 a.m. to 7 p.m. If you are a Highmark network provider and have not signed up for NaviNet, learn how to do sohere. please email the case number and request to: reqcriteria@eviCore.com. Effective May 1, 2023, AmeriHealth Caritas North Carolina (ACNC) will require prior authorization via eviCore healthcare for selected health care services. Do you offer a mandatory prior authorization program for all sleep studies? Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. Contact your designated Independence Provider Network Services (PNS) team contact. How does eviCore interact with providers? To view this file, you may need to install a PDF reader program. External link You are leaving this website/app (site). Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Preventive Care Outreach: Partnering to Improve Health Outcomes, Lower Costs and Increase CMS Scores, Q&A: eviCores Dr. Lon Castle on Evidence-Based Lab Testings Ability to Improve Patient Outcomes & Reduce Costs, eviCores Dr. Robert Westergan on Managing Site of Care and Implants for Musculoskeletal (MSK) Conditions, Check Status of Existing Prior Authorization. In addition, some sites may require you to agree to their terms of use and privacy policy. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. All Rights Reserved. You're being redirected to the CMS search site. Directory Who to Contact for Preauthorization All providers must verify member eligibility and benefits prior to rendering non-emergency services. The diagnostic exams requiring prior authorization generally include the following procedures*: *prior authorization of certain procedures can vary by health plan. Subject: Sign- up for eviCore Healthcare's Training for new Prior Authorization requirements! 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! The instructions on how to submit a case and a link to the correct portal to use will be provided. Medical Oncology: Call: 1 (866) 668-9250 Fax: 1 (800) 540-2406. Meet Dr. Scarborough, Chief of Radiology & SVP of Medical Affairs. This new site may be offered by a vendor or an independent third party. Please join us in reflecting back on the best moments from Auth the Cuff in 2020. <> eviCore made it easy to complete my primary task online. 410 N. 44th Street, Suite 900. . The site may also contain non-Medicare related information. To request any additional assistance in accessing the guidelines, . Privacy Policy | Annual Utilization Statistics | CareCore National Web Portal Friday, April 28, 2023 10:41 AM For log in problems: Please try the email address that you registered with as your user name. MCG Clinical Criteria- Information on Highmark's incorporation of MCG Health evidence-based clinical guidelines into Highmarks criteria of clinical decision support. Call Utilization Management at 855-339-8127, 9 a.m to 9 pm., Monday through Friday. What is included in the Medical Oncology program? Information for Blue Cross and Blue Shield of Illinois (BCBSIL) members is found onour member site. What is included in eviCores Comprehensive Oncology program? This is not an all-inclusive list. Annual Utilization Statistics | open positions so continue your job search at Cigna.com/careers. The list applies to the following EmblemHealth lines of business: GHI Commercial non-City of New York. Frequently asked questions about requesting authorization from eviCore healthcare eviCoreis an independent company that provides specialty medical benefits management for BCBSTX. Call 1-800-TALK-MVP (1-800-825-5687) to speak with an MVP representative. 1-800-972-8382. Check Status of Existing Prior Authorization. Emergency room visits don't require prior authorization. BCBSAZ Health Choice requires all non-contracted dentists to obtain a Prior Authorization before rendering treatment. reCAPTCHA is not valid; Please try again! Were still hiring for other For more specific contact information, choose the statement below that best represents you. Thank you for using eviCores website today! Were still hiring for other Registration, user access/ account assistance, portal navigation, error message understanding. What is included in the Radiology solution? Q4: How can eviCore make it easier for you to use this website? How does my doctor access the Specialty Drug Management solution? information about accessing the eviCore portal. eviCore made it easy to complete my primary task online. What is the fastest way to do this? of authorization request(s). Additional information on authorizations can be found in Chapter 5 (Care & Quality Management) of the Highmark Provider Manual. IMPORTANT: In the coming days, we will be migrating systems for our To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers open positions so continue your job search at Cigna.com/careers. eviCore fax number: (800) 540-2406 Web Portal Services-Assistance 4 Web Support Phone: 800-646-0418 (Option 2) Email: portal.support@evicore.com Web Portal Services-Available 24/7 Pre-Certification Call Center Web-Based Services Client Provider Operations Documents Client Provider Operations Pre-Certification Call Center % As a provider outside of Michigan who is not contracted with us, you should submit Medicare authorization requests via fax, using the proper prior authorization form. Report concerns to the BCBSIL Special Investigations Department (SID) Fraud website 1 . Services requiring prior authorization through eviCore are outlined below. [{"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. For additional resources on the Helion Arc authorization process, includinginstructionalvideos,CLICK HERE. 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". In addition, peer-reviewed literature, major treatises, input from health plans, and practicing academic and community-based physicians are also utilized in the construction of our guidelines. Obtain prior authorizations through eviCore using one of the following methods: eviCoreperiodically will host orientation sessions for providers for various care categories. Always check eligibility and benefits first,via theAvailityEssentialsor your preferred web vendor, prior to rendering care and services. Which EHRs does eviCores intelliPath ePA support? Report Fraud & Abuse | If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. Please click here to register for an account. Beginning Friday, December 18th at 5:00pm EST, you Sometimes, a plan may require the member to request prior authorization for services. endstream endobj startxref Prior authorization requests for our Blue Cross Medicare Advantage (PPO) SM (MA PPO), Blue Cross Community Health Plans SM (BCCHP SM) and Blue Cross Community MMAI (Medicare-Medicaid Plan) SM members can be submitted to eviCore in two ways. Inpatient Planned Requests: Call Highmark Clinical Services; Press 2 for authorization requirements/ status. Many changes will take effect \u003cstrong\u003eJuly 6, 2023\u003c/strong\u003e. Were still hiring for other Learn about the growing field, along with eviCore and Alegis Care's home solutions on our new Auth the Cuff podcast episode with Dr. Yvette LeFebvre, Chief of PAC/DME/Sleep Services. Please click here to register for an account. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * I need to change the date on my request. Availity provides administrative services to BCBSIL. Highmark has partnered witheviCorehealthcare (eviCore) for the following programs: Highmarkcontracts withWholeHealth Networks, Inc. (WHN), a subsidiary of Tivity Health Support, LLC.,forphysical medicine services- and naviHealth for Post-Acute Care for Medicare Advantage members. eviCore intelliPath . Annual Utilization Statistics | Create an Account. Availity is a trademark of Availity, LLC., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Privacy Policy | 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. Remember, member benefits and review requirements will vary based on service/drug being rendered and individual/group policy elections. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status endobj Annual Utilization Statistics | GEHA, like other federal medical plans, requires providers to obtain authorization before some services and procedures are performed. Fax (24-hour) at 866-809-1370 . wont be able to apply to eviCore openings. Copyright 2022 eviCore healthcare. All Rights Reserved. What services are managed through the Musculoskeletal Surgical Program? How will prior authorization determinations be communicated? Dont I have to go to a hospital for my procedure? In addition, some sites may require you to agree to their terms of use and privacy policy. Ethics & Compliance | 0 Terms of Use | Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 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. Credentialing Credentialing and joining our network - 1-800-353-1232 (TTY: 711) Special programs and other phone numbers Availity help - registration questions, help with user name/password - 1-800-282-4548 . Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. Were still hiring for other Multi-Factor Authentication (MFA) is now live on eviCores web portal! Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Tune into our recent podcast episode with eviCore's post-CAM program specialists Dr. Chanta Van Laanen, Dr. Laura Beitz-Walters and Dr. Mark Leichter to learn more. Behavioral health. Services billed with the following revenue codes always require prior authorization: 0240-0249 All-inclusive ancillary psychiatric. In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. See Clinical Corner for services that require Preauthorization. PPO members You don't need to worry about referrals. Member Rights Policy | Please click here to register for an account. reCAPTCHA is not valid; Please try again! What can chiropractic services do for my lower back pain? 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, %%EOF BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. 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. Call 1-888-233-8158 from 8:00 a.m. to 9:00 p.m., Eastern, Monday through Friday. Forgot Password? Click herefor the MFA registration & setup guide. Report Fraud & Abuse | How does a provider check the prior authorization status for a member? You are leaving this website/app (site). Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST. Q4: How can eviCore make it easier for you to use this website? 800.918.8924, For media inquiries please contactmedia@evicore.com. ** Exception: Diabetic shoes and inserts are handled by Northwood, Inc . The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. Apr 06, 2023. Benefits can vary; always confirm member coverage. Electronic Data Interchange (EDI) Email: EDI@premera.com BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. Prior authorization lookup tool. Intake form. E-Verify and IER Right to Work. reCAPTCHA is not valid; Please try again! eviCore made it easy to complete my primary task online.
