endstream endobj 540 0 obj <. of authorization request(s). Dr. Torelli and Liz Avila are back today discussing the growing issue of rising healthcare costs. Obtain prior authorizations through eviCore using one of the following methods: eviCoreperiodically will host orientation sessions for providers for various care categories. To contact Customer Care, please call the phone number on the back of your Member ID Card. You can request an expedited appeal by calling the prior authorization number for the plan that covers your patient. Contact us Chat with us now. What digital resources can I access to find out more information? How does a computer make healthcare decisions? wont be able to apply to eviCore openings. Listen to our latest podcast episode with new host, Dr. Emily Coe featuring Dr. Mayank Shah. Fraud Hotline. [{"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. In general, there arethreestepsprovidersshould follow. eviCore currently maintains a nationwide advanced imaging network, featuring contracts with providers of imaging services in specific/predetermined locationsand as well as freestanding facilities. Were still hiring for other Terms of Use | 2 0 obj Copyright 2022 eviCore healthcare. By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. You will receive a letter in the mail and your physician will receive a letter via fax communicating this information. What do I tell my patient when their case is denied? EmblemHealth Preauthorization List. Terms of Use | Please retain the confirmation email. One option is Adobe Reader which has a built-in reader. 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. The system can easily be made an extension of the clients existing claims workflow. Beginning Friday, December 18th at 5:00pm EST, you Copyright 2022 eviCore healthcare. Moreover, eviCore is the only company in the industry with dedicated, separately maintained pediatric guidelines. Simply visit the eviCores Providers Hub page and select the health plan and solution option for your case in the training section. Pharmacy Prior Authorization eviCore Medical Oncology Drug List Why would I switch to intelliPath ePA? Effective May 1, 2023, AmeriHealth Caritas North Carolina (ACNC) will require prior authorization via eviCore healthcare for selected health care services. open positions so continue your job search at Cigna.com/careers. Which EHRs does eviCores intelliPath ePA support? How does my doctor access the Specialty Drug Management solution? Some procedures may also receive instant approval. we will be implementing changes to evicore.com in the near future. Visit www.evicore.com Call 800.533.1206 Monday - Friday: 7:00 a.m. to 7:00 p.m. The procedure codes contained in the lists below usually require authorization (based on the members benefit plan/eligibility). Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) prior to performing the procedure or service. eviCore interacts with radiology patients in two ways. Fax all requests for services that require prior authorization to: Inpatient: 1-844-430-6806. EmblemHealth Reduces Preauthoriz . eviCore made it easy to complete my primary task online. Trials, Treatments, and Oncology Breakthroughs, Check Status of Existing Prior Authorization. All Prior Authorizations can be submitted online, except the following: Must besubmitted via the appropriate fax line or by phone at 1-888-FIDELIS (1-888-343-3547): Urgent Requests o Initial Inpatient Rehabilitation can now be submitted online via provider portal o Inpatient Emergency Room Admission Requests Concurrent Requests Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization. The table will help you determine if you can use the approved prior authorization, modify the original or request a new one. eviCore made it easy to complete my primary task online. How do I know when my test has been authorized? Electronic Data Interchange (EDI) Email: EDI@premera.com endobj Please check directly with your health plan for specific requirements or contact eviCores Customer Service at (800) 918-8924. $4d? vI Contact Us; Search. What types of radiology procedures require prior authorization? Ethics & Compliance | Ethics & Compliance | What additional tools are available as add-on programs to the Cardiovascular solution? Dont I have to go to a hospital for my procedure? The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. Eligibility Verification Providers should verify member eligibility prior to requesting/providing services. All Requests: Utilize Authorization Inquiry function in NaviNet. Most PDF readers are a free download. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status IMPORTANT: In the coming days, we will be migrating systems for our Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. eviCore positions. eviCore positions. If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. Prior authorization lookup tool. What services are managed through the Musculoskeletal Therapies Program? *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Member Rights Policy | Prior authorization fax: 800-267-8328 Behavioral health prior authorization fax: 877-840-5581. Thank you for using eviCores website today! eviCore made it easy to complete my primary task online. 3 0 obj Please click here to register for an account. If the provider or member doesnt get prior authorization for out-of-network services, the claim may be denied. <> As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Fax (24-hour) at 866-809-1370 . Find Contact Information; Podcasts; GO TO PROVIDER'S HUB. Q1: Overall, how satisfied are you with eviCores website? Q1: Overall, how satisfied are you with eviCores website? 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, This new site may be offered by a vendor or an independent third party. Do you ever ask the question about why you might need that MRI or CT scan? eviCore intelliPath streamlines operations within a single easy-to-use application that integrates with major EHRs. The authorization is typically obtained by the ordering provider. Forgot Password? Step 2If prior authorization is required, have the following information ready: Step 3 Submit Your Prior Authorization Request. Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. Care Management Programs Utilization Management (Prior Authorizations), STAR Kids Referral and Authorization Process, Value-Added Services for STAR, CHIP and STAR Kids, Medicaid Provider Information on COVID-19 Coverage, Quality Improvements (QI) Toolkits and Tip Sheets, Home Delivery Pharmacy (Mail-Order Pharmacy), Medicaid (STAR) and CHIP Prior Authorization Forms. 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, endobj All Rights Reserved. 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. Privacy Policy | Prior authorization is required by Carelon Medical Benefits Management (formerly AIM . Telehealth, Telemedicine Hologram Care? Authorizations for HDHP, Standard and High Option members 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. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. Copyright 2022 eviCore healthcare. <> Registration, user access/ account assistance, portal navigation, error message understanding. eviCores innovative SmartChoice program serves as a patient-outreach service that educateshealth plan members on available options for their advanced imaging procedure locations. 888-482-8057 Mon.-Fri., 8am - 11pm ET Sat., 8am - 3pm ET. wont be able to apply to eviCore openings. Use the link and toll-free phone number to access your training. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status For additional resources on the Helion Arc authorization process, includinginstructionalvideos,CLICK HERE. . Part of it involves making sure the computer speaks the same language as the medical records. Phone - Call eviCore toll-free at 855-252-1117 . The Member Customer Care Center is open Monday-Friday, 8 am to 6 pm (ET). The site may also contain non-Medicare related information. You can also see eviCore healthcare's criteria and get request forms at . MEDICAL POLICIES % Emily Coe, PhD interviews eviCore's Dr. Mary Kay Barton, Sr. Medical Director, Medical Oncology, and Dr. Gary Jones, Associate Medical Director, Medical Oncology, for an enlightening conversation on clinical trials in pediatric and adult oncology, treatment innovations, and more. eviCore made it easy to complete my primary task online. reCAPTCHA is not valid; Please try again! Please use the BCBSAZ MA prior authorization fax form or the eviCore online request tool, available on the secure MA . Apr 06, 2023. Beginning Friday, December 18th at 5:00pm EST, you Outpatient: 1-844-442-8012. Call 1-888-233-8158 from 8:00 a.m. to 9:00 p.m., Eastern, Monday through Friday. Use theAvailityProvider Portalor your preferred vendor to check eligibility and benefits before rendering services. To view this file, you may need to install a PDF reader program. Well before the pandemic, consumers were leaning towards home healthcare versus facility based care when appropriate for a number of reasons. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Review claim status and request claim adjustments. eviCore intelliPath reflects eviCores commitment to modernize prior authorization and remove barriers to evidence-based care. endstream endobj startxref Claims UnitedHealthcare Community Plan Quest Integration P.O.Box 31365 Salt Lake City, UT 84131-0365 Payer ID#: 87726 (EDI Claims Submission) Claims Optum P.O. Check eligibility and benefits for members. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 1-800-624-0756 (TTY: 711) for HMO and Medicare Advantage benefits plans. Hospitals should contact CareAllies at (800) 227-9360 to obtain prior authorization. 410 N. 44th Street, Suite 900. For many services, we manage the precertification process directly. Box 30757 Salt Lake City, UT 84130-0757 Payer ID#: 87726 (EDI claims submission) Pharmacy Terms of Use | 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. Certain outpatient procedures, services, supplies. %PDF-1.6 % Report Fraud & Abuse | This new site may be offered by a vendor or an independent third party. How does eviCore interact with Post-Acute Care patients? 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. Helpful Resources: Authorization Grids Please click here to register for an account. Privacy Policy | 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. All Rights Reserved. Check status of submitted authorizations. Lab Prior Authorization CPT Code List. Create an Account. How will prior authorization determinations be communicated? Check eligibility and benefits for members. GEHA, like other federal medical plans, requires providers to obtain authorization before some services and procedures are performed. Watch or listen to the latest Auth the Cuff podcast episode with our host, Dr. Emily Coe, featuring Dr. Joseph Weiss, where we discuss all things gastroenterology. Were still hiring for other The instructions on how to submit a case and a link to the correct portal to use will be provided. Please click here to register for an account. Please click here to register for an account. 1-888-MDAETNA (1-888-632-3862) (TTY: 711) for all other plans. The associated preauthorization forms can be found here. Annual Utilization Statistics | For inpatient hospital stays, your doctor will get prior authorization from HAP. 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". The terms of the members plan control the available benefits. What can physical therapy do for my lower back pain? Watch this weeks episode of Auth the Cuff to learn more! *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * What is included in the Cardiovascular solution? Learn more from eviCore experts Sid Govindan, MD and John Young on how eviCore is applying these technologies to evolve the prior authorization process. Member Rights Policy | 571 0 obj <>stream Services requiring prior authorization through eviCore are outlined below. Pre-authorization Electronic authorizations Use Availity's electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. Privacy Policy | eviCore will communicate the determination utilizing the following methods: Our hosts Dr. Torelli and Liz Avila are here to explain why. Prior authorization is a process that is often criticized for denying carebut is actually designed to protect patients by ensuring they get the right care. Effective dates are subject to change. All Rights Reserved. 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. reCAPTCHA is not valid; Please try again! Provider costs are reduced and decisions are communicated in real time, reducing delays. Step 1 Confirm if Prior Authorization is Required. Certain employer groups may require prior authorization or pre-notification through other vendors. Always check eligibility and benefits first,via theAvailityEssentialsor your preferred web vendor, prior to rendering care and services. Why do we recommend conservative treatment options first? What is included in the Radiology solution? ** Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. Medical Oncology: Call: 1 (866) 668-9250 Fax: 1 (800) 540-2406. Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. Thank you for submitting information. Online forms from eviCore's carriers hub MENU PROVIDERS About; Solutions. Echocardiograms also just so happen to be one of the most common inappropriately ordered tests. Prescription drug prior authorization 24 hours a day, 7 days a week: 1-888-678-7015 Fax: 1-888-671-5285: . Terms of Use | Beginning Friday, December 18th at 5:00pm EST, you How does a provider check the prior authorization status for a member? Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Review claim status and request claim adjustments. I need to change the date on my request. Q4: How can eviCore make it easier for you to use this website? of authorization request(s). Hospital and Outpatient Services. You may also go directly to eviCore's self-service web portal at www.evicore.com. Note: Most out-of-network services require utilization management review. Prior Authorizations. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. Ethics & Compliance | 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, If you have any questions about this notice, please the Prior Authorization Department at (646) 473-7446. 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. (This information should not be relied on as authorization for health care services and is not a guarantee of payment.). eviCore intelliPath . What do I do if a members eligibility is incorrect or not on file? For Prior Authorization requests, use one of the following: CoverMyMeds: Website: CoverMyMeds.com (Preferred) Call: 1 (877) 813-5595 Why didn't you call me the last time I had a procedure? All Rights Reserved. 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. Health Plans. eviCore positions. eviCore healthcare (eviCore) Obtain benefit preauthorization for certain care categories. We already use the eviCore portal. Call 1 (800) 88CIGNA (882-4462). 400 Buckwalter Place Blvd. All Rights Reserved. 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. we will be implementing changes to evicore.com in the near future. 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. For quick reference, see the GEHA member's ID card. Moving forward, please visit CoverMyMeds or via SureScripts in your EHR to learn more and submit all new PA requests electronically. Providers and/or staff can request prior authorization and make revisions to existing cases by calling 1-866-496-6200. 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. 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.
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