What digital resources can I access to find out more information? Q4: How can eviCore make it easier for you to use this website? The site may also contain non-Medicare related information. eviCore.com. 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: Benefits can vary; always confirm member coverage. 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. 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. Intake form. I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? Ethics & Compliance | 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 . How do I know when my test has been authorized? Lab Prior Authorization CPT Code List. Step 1 Confirm if Prior Authorization is Required. eviCore intelliPath reflects eviCores commitment to modernize prior authorization and remove barriers to evidence-based care. 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, eviCore positions. If you donotget prior approval via the prior authorization process for services and drugs on our prior authorization lists: When and how should prior authorization requests be submitted? Terms of Use | What is included in the Radiology solution? The system can easily be made an extension of the clients existing claims workflow. 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. 888-482-8057 Mon.-Fri., 8am - 11pm ET Sat., 8am - 3pm ET. How does eviCore handle large gene panels? * eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSTX. Benefits > CHS Group Information" or call the prior authorization phone number on back of the member's ID card. 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. Highmark recently launched the Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. Register Now IMPORTANT: In the coming days, we will be migrating systems for our services by chiropractors. Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. 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. endstream endobj 540 0 obj <. wont be able to apply to eviCore openings. Click herefor the MFA registration & setup guide. information about accessing the eviCore portal. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, CAR-T Cell Therapy & Medical Oncology Disparities, Crunching the Numbers! Terms of Use | While very useful when used appropriately, these studies have established some new guidelines to follow around this important test. If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. 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. Beginning Friday, December 18th at 5:00pm EST, you All web users may now protect their portal accounts with an additional layer of security, including e-mail & SMS. To viewrequirements summaries andprocedure code lists, refer to theSupport Materials (Commercial)andSupport Materials (Government Programs)pages. Our hosts Dr. Torelli and Liz Avila are here to explain why. 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. of authorization request(s). Fraud Hotline. For more information about prior authorization, please review Mercy Care's Provider Manuals located under the Provider Information tab on our website. The Member Customer Care Center is open Monday-Friday, 8 am to 6 pm (ET). eviCore made it easy to complete my primary task online. Driving Directions Use theAvailityProvider Portalor your preferred vendor to check eligibility and benefits before rendering services. 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. Call Utilization Management at 855-339-8127, 9 a.m to 9 pm., Monday through Friday. 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! EmblemHealth Reduces Preauthoriz . What additional tools are available as add-on programs to the Cardiovascular solution? 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 Thank you for using eviCores website today! Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Dr. Torelli and Liz Avila are back today discussing the growing issue of rising healthcare costs. 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. Effective 10/13/2017 - 12/31/2020. Many changes will take effect \u003cstrong\u003eJuly 6, 2023\u003c/strong\u003e. Echocardiograms also just so happen to be one of the most common inappropriately ordered tests. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * If the requested exam is denied, eviCore will notify both you and your physician and provide you with detailed appeal instructions. Providers and/or staff can request prior authorization and make revisions to existing cases by calling 1-866-496-6200. For quick reference, see the GEHA member's ID card. Username Password Register for an account Retrieve Username Retrieve Password IMPORTANT: In the coming days, we will be migrating systems for our Once a prior authorization request is received and processed, the decision is communicated to the provider. You may also go directly to eviCore's self-service web portal at www.evicore.com. External link You are leaving this website/app (site). In addition, some sites may require you to agree to their terms of use and privacy policy. Were still hiring for other Beginning Friday, December 18th at 5:00pm EST, you All Rights Reserved. Step 2If prior authorization is required, have the following information ready: Step 3 Submit Your Prior Authorization Request. Our proprietary integrated system, Claims Studio, delivers savings through an enhanced focus on accurate claims payment. Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, Behavioral Health IP PA - IVR Caller Guide, Behavioral Health OP PA - IVR Caller Guide, Inpatient Preauthorization - IVR Caller Guide, Outpatient Preauthorization - IVR Caller Guide, Preauthorization: Check Request Status - IVR Caller Guide, Utilization Management Process Overview (Commercial), Patients medical or behavioral health condition, Date of service, estimated length of stay (if the patient is being admitted), Provider name, address and National Provider Identifier (NPI), Government Programs 877-774-8592 (MA PPO); 877-860-2837 (BCCHP); 877-723-7702 (MMAI). Provider costs are reduced and decisions are communicated in real time, reducing delays. its a guideline to help us practice medicine better, and to keep safety in mind for our patients by not over utilizing explains Dr. Robert Good, VP & Associate Chief Medical Officer for Carle Health, on how eviCores solutions have made a difference for their patients in the newest Auth the Cuff podcast. By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. All Rights Reserved. Sign in Learn more about electronic authorization Pre-authorization lists Commercial Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. The instructions on how to submit a case and a link to the correct portal to use will be provided. In general, there arethreestepsprovidersshould follow. Our host Emily Coe, PhD, speaks with Alegis Care social worker Katie Sherman, MSW, LCSW, to learn more about home health, social determinants of health, access to care, and more. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. ** Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. 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. Tune into our new Auth the Cuff episode with eviCore's Dianne Doherty, Sr. stream In practice, utilization management plays a large role in patient safety and empowerment. Ethics & Compliance | eviCore made it easy to complete my primary task online. PPO members You don't need to worry about referrals. eviCore healthcare (eviCore) Obtain benefit preauthorization for certain care categories. Frequently asked questions about requesting authorization from eviCore healthcare Review claim status and request claim adjustments. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. . 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. %PDF-1.5 Were still hiring for other What types of services are managed under your sleep solution? Member Rights Policy | of authorization request(s). Health Plans. Reminding and guiding patients to get the care they need. Copyright 2022 eviCore healthcare. Preauthorization Lists New Empire Precertification Requ . Hospital and Outpatient Services. $4d? vI If the provider or member doesnt get prior authorization for out-of-network services, the claim may be denied. 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 . eviCore intelliPath . 539 0 obj <> endobj What are my options when a case is denied? The reality is, most providers weren't initially trained to deliver virtual care. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status of authorization request (s). For additional resources on the Helion Arc authorization process, includinginstructionalvideos,CLICK HERE. What services are managed through the Musculoskeletal Surgical Program? 571 0 obj <>stream (This information should not be relied on as authorization for health care services and is not a guarantee of payment.). One option is Adobe Reader which has a built-in reader. For Prior Authorization requests, use one of the following: CoverMyMeds: Website: CoverMyMeds.com (Preferred) Call: 1 (877) 813-5595 We already use the eviCore portal. You can request an expedited appeal by calling the prior authorization number for the plan that covers your patient. 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. Authorization number not appearing, unable to locate member, questions about clinical criteria screen. Register Now 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. 4 0 obj <>>> IMPORTANT: In the coming days, we will be migrating systems for our AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. Or you can call Provider Services at . 0901, 0905-0907, 0913, 0917 Behavioral health treatment services. Visit www.evicore.com Call 800.533.1206 Monday - Friday: 7:00 a.m. to 7:00 p.m. Usually, the provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider. 0 Beginning Friday, December 18th at 5:00pm EST, you Call 1-888-233-8158 from 8:00 a.m. to 9:00 p.m., Eastern, Monday through Friday. You are leaving this website/app (site). The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. 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. Clinical Resourcespage on theBCBSTX Medicaidwebsite. Our network of quality providers offers an attractive option for health plansseeking to more appropriately manage radiology benefits. 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. : Chiropractic Low Back Pain, Gastroenterology Is Turning Science Fiction Into Reality, Healthcare Its Simpler Than We All Think, Just Because You Can, Doesnt Mean You Should, New Perspective, Same Focus: Utilization Management & Patient Safety, Redefining Home Healthcare and Reducing (Re)Admissions, Specialized Therapy Services: Reducing Pain and Beyond. open positions so continue your job search at Cigna.com/careers. Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. Remember, member benefits and review requirements will vary based on service/drug being rendered and individual/group policy elections. PROVIDERS AREA. 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. open positions so continue your job search at Cigna.com/careers. 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. 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. What is the fastest way to do this? endobj Or . Ethics & Compliance | open positions so continue your job search at Cigna.com/careers, Were on a quest to improve the experience of administrators, clinicians, and patients who work with us. Were still hiring for other Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 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. Mailing address. Q4: How can eviCore make it easier for you to use this website? 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. Prior authorization isrequiredfor some members/services/drugsbefore services are rendered to confirm medical necessity as defined by the members health benefit plan. Service preapproval is based on the members benefit plan/eligibility at the time the service is reviewed/approved. A prior authorization isnota guarantee of benefits or payment. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. What is included in the Cardiovascular solution? wont be able to apply to eviCore openings. Services billed with the following revenue codes always require prior authorization: 0240-0249 All-inclusive ancillary psychiatric. So how do we continue to think about best practices for telehealth? To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers [{"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. Registration, user access/ account assistance, portal navigation, error message understanding. External link You are leaving this website/app (site). We would like to help. we will be implementing changes to evicore.com in the near future. Thank you for using eviCores website today! eviCore positions. Fax all requests for services that require prior authorization to: Inpatient: 1-844-430-6806. Tune into our latest Auth the Cuff podcast episode featuring pediatric oncologists Dr. Michelle Neier and Dr. Jessica Roberson, along with pediatric radiologist Dr. Keith Kronemer, who speak with Dr. Emily Coe on the impact COVID-19 has had, and may continue to have, on pediatric care. In addition, some sites may require you to agree to their terms of use and privacy policy. Register Now 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. The sleep management program does this by helping to ensure that appropriate sleep testing practices are followed and by supporting customers' use of PAP therapy. reCAPTCHA is not valid; Please try again! As a valued user of our website, wed appreciate your feedback to help us improve your website experience.
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