Annual Utilization Statistics | 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). If you need preauthorization, contact eviCore in one of three ways: Get immediate approval by submitting your request at www.evicore.com. 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". we will be implementing changes to evicore.com in the near future. GHI Medicare non-City of New York. The site may also contain non-Medicare related information. So how do we continue to think about best practices for telehealth? For inpatient hospital stays, your doctor will get prior authorization from HAP. Information for Blue Cross and Blue Shield of Illinois (BCBSIL) members is found onour member site. 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. Todays Auth the Cuff podcast is talking really high-tech: artificial intelligence, natural language processing, statistical modeling, oh my! Please check directly with your health plan for specific requirements or contact eviCores Customer Service at (800) 918-8924. What is included in the Radiology solution? hbbd```b`` {dd"Xdw&e7eu"j`RH2f@d\B;IH~ Q4: How can eviCore make it easier for you to use this website? *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. Privacy Policy | Note: Checking eligibility and benefits is key, butwe also have other resources to help you prepare. Behavioral health. Prior authorization is required by Carelon Medical Benefits Management (formerly AIM . How do I know when my test has been authorized? As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Member Rights Policy | In addition, some sites may require you to agree to their terms of use and privacy policy. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. For commercialprior authorization requests handled by AIM Specialty Health(AIM): Commercial non-HMO prior authorization requests can be submitted to AIM intwo ways. 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. Sessions offered May and June. <> Some requests are handled by BCBSIL; others are handled by utilization management vendors. Finally, eviCore manages select cardiology and radiology services for dates of service prior to Oct. 1, 2018, including postservice requests. How does eviCore communicate with the patients provider? I got a message from a SmartChoice representative asking me to call back; why are you calling me? Authorizations for HDHP, Standard and High Option members What services are managed through the Musculoskeletal Therapies Program? I need to change the date on my request. we will be implementing changes to evicore.com in the near future. 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). Fax 866-873-8279. Q4: How can eviCore make it easier for you to use this website? Why would I switch to intelliPath ePA? Prior authorization is required by eviCore healthcare for services performed for adult 400 Buckwalter Place Blvd. Our proprietary integrated system, Claims Studio, delivers savings through an enhanced focus on accurate claims payment. Create an Account. 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, Please click here to register for 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. Report Fraud & Abuse | What is included in eviCores Comprehensive Oncology program? Visit www.evicore.com Call 800.533.1206 Monday - Friday: 7:00 a.m. to 7:00 p.m. This podcast was created with the providers in mind. Lab Prior Authorization CPT Code List. Our network of quality providers offers an attractive option for health plansseeking to more appropriately manage radiology benefits. To contact Customer Care, please call the phone number on the back of your Member ID Card. $4d? vI . 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. 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. To request any additional assistance in accessing the guidelines, . Use the link and toll-free phone number to access your training. GEHA, like other federal medical plans, requires providers to obtain authorization before some services and procedures are performed. Please use the BCBSAZ MA prior authorization fax form or the eviCore online request tool, available on the secure MA . Beginning Friday, December 18th at 5:00pm EST, you We recognize that providers today navigate a complicated healthcare system while trying to make the best medical decisions for their patients. It indicates which codes are handled by a vendor. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the members policy certificate and/or benefits booklet and or summary plan description. Electronic Data Interchange (EDI) Email: EDI@premera.com Highmark recently launched the Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. Prior authorization lookup tool. You're being redirected to the CMS search site. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. What is the fastest way to do this? Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Online forms from eviCore's carriers hub MENU PROVIDERS About; Solutions. External link You are leaving this website/app (site). Check Status of Existing Prior Authorization. Please click here to register for an account. Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. Please click here to register for an account. % Terms of Use | The procedure codes contained in the lists below usually require authorization (based on the members benefit plan/eligibility). wont be able to apply to eviCore openings. Q1: Overall, how satisfied are you with eviCores website? Continue to Authorization Lookup Login Log In Forgot User ID? Telephone:For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. %PDF-1.6 % Services billed with the following revenue codes always require prior authorization: 0240-0249 All-inclusive ancillary psychiatric. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * There is a notion of utilization management being solely focused on cost savings. You can verify benefits and request prior authorization at Availity.com or by phone at 1-888-693-3211 1-888-693-3211. \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). Call 1-888-233-8158 from 8:00 a.m. to 9:00 p.m., Eastern, Monday through Friday. Continue to Authorization Lookup Login Log In Forgot User ID? Annual Utilization Statistics | Contact J&B at 1-888-896-6233 or . You can fax your authorization request to 1-800-217-9345. . This new site may be offered by a vendor or an independent third party. Q1: Overall, how satisfied are you with eviCores website? BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. The terms of the members plan control the available benefits. 2 0 obj All Requests: Utilize Authorization Inquiry function in NaviNet. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, CAR-T Cell Therapy & Medical Oncology Disparities, Crunching the Numbers! Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Thank you for using eviCores website today! BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. Reminding and guiding patients to get the care they need. Check status of submitted authorizations. 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. Prescription drug prior authorization 24 hours a day, 7 days a week: 1-888-678-7015 Fax: 1-888-671-5285: . What digital resources can I access to find out more information? Member Rights Policy | Most PDF readers are a free download. Some authorization requirements vary by member contract. 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. Directory Who to Contact for Preauthorization All providers must verify member eligibility and benefits prior to rendering non-emergency services. Participating providers can find more precertification phone numbers in Participating provider precertification list for Aetna (PDF). Forgot Password? Contact Us; Search. For many services, we manage the precertification process directly. Beginning Friday, December 18th at 5:00pm EST, you Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. 1-888-693-3211 (TTY: 711). Moreover, eviCore is the only company in the industry with dedicated, separately maintained pediatric guidelines. Provider costs are reduced and decisions are communicated in real time, reducing delays. The "Live Sessions" page will display. eviCores evidence-based Radiology Clinical guidelines are based upon major national and international association and society guidelines and criteria. How does eviCore interact with providers? . To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers Trials, Treatments, and Oncology Breakthroughs, Check Status of Existing Prior Authorization. of authorization request(s). 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. If you do not hear back from us within 5 business days, please call, Please enter provider primary location address. How does a provider check the prior authorization status for a member? eviCore.com 1-855-252-1117. Another part is having access to an exceptionally large volume of historical cases. Prior authorization isrequiredfor some members/services/drugsbefore services are rendered to confirm medical necessity as defined by the members health benefit plan. If you have any questions about this notice, please the Prior Authorization Department at (646) 473-7446. Copyright 2022 eviCore healthcare. What services are managed through the Musculoskeletal Pain Management Program? 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. 1-800-624-0756 (TTY: 711) for HMO and Medicare Advantage benefits plans. We also provide helpful resources on how to navigate the prior authorization process, including provider playbooks and tips on how to maximize the process short of a peer-to-peer phone call. Were still hiring for other hb```|7@($qFqr&kX Q8rC%xd]ZG{5LA[K;:]*${;fR4kE[zGV@EFH;!Az. reCAPTCHA is not valid; Please try again! Why was my test, treatment, or procedures not approved? As a valued user of our website, wed appreciate your feedback to help us improve your website experience. 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, Watch this weeks episode of Auth the Cuff to learn more! Moving forward, please visit CoverMyMeds or via SureScripts in your EHR to learn more and submit all new PA requests electronically. Privacy Policy | Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. reCAPTCHA is not valid; Please try again! 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, 3 0 obj eviCores new electronic prior authorization eviCore intelliPath is already being deployed inside the existing prior authorization workflow and by provider organizations to automate and simplify the process of submitting and tracking requests for prior authorization. we will be implementing changes to evicore.com in the near future. Call Center: eviCore's is available from 7 a.m. to 7 p.m. Forgot Password? How does eviCore interact with Post-Acute Care patients? 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. To view this file, you may need to install a PDF reader program. 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. of authorization request(s). See Clinical Corner for services that require Preauthorization. Learn more from eviCore experts Sid Govindan, MD and John Young on how eviCore is applying these technologies to evolve the prior authorization process. Which EHRs does eviCores intelliPath ePA support? reCAPTCHA is not valid; Please try again! What can physical therapy do for my lower back pain? If you do not remember your password, please click "Retrieve Password" below. information about accessing the eviCore portal. Privacy Policy | Frequently asked questions about requesting authorization from eviCore healthcare In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. What are my options when a case is denied? Hospitals should contact CareAllies at (800) 227-9360 to obtain prior authorization. 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. Hospital and Outpatient Services. Fraud Hotline. This is not an all-inclusive list. 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. of authorization request(s). 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. we will be implementing changes to evicore.com in the near future. eviCores innovative SmartChoice program serves as a patient-outreach service that educateshealth plan members on available options for their advanced imaging procedure locations. The system can easily be made an extension of the clients existing claims workflow. 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). open positions so continue your job search at Cigna.com/careers. 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. As a result, eviCore helps reduce inappropriate utilization, unnecessary radiation exposure, and invasive procedures and thereby improves patient safety. 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. If the provider or member doesnt get prior authorization for out-of-network services, the claim may be denied. open positions so continue your job search at Cigna.com/careers. 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, 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. Were on a quest to improve the experience of administrators, clinicians, and patients who work with us. Some procedures may also receive instant approval. Annual Utilization Statistics | 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. You'll find more information on authorizations in the GEHA plan brochure. To view this file, you may need to install a PDF reader program. Sometimes, a plan may require the member to request prior authorization for services. Obtain prior authorizations through eviCore using one of the following methods: eviCoreperiodically will host orientation sessions for providers for various care categories. Eligibility Verification Providers should verify member eligibility prior to requesting/providing services. Ethics & Compliance | Check eligibility and benefits for members. eviCore positions. Manage practice information, access staff training and complete attestation requirements. we will be implementing changes to evicore.com in the near future. How do I obtain clinical certification for cardiovascular tests? Manage practice information, access staff training and complete attestation requirements. 0 Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. Why do we recommend conservative treatment options first? The online portal is designed to facilitate the processing ofauthorizationrequests in a timely, efficient manner. Utilization Management. open positions so continue your job search at Cigna.com/careers, Something went wrong.Please try again after some time, Thank you for submitting. 539 0 obj <> endobj What services are managed through the Musculoskeletal Surgical Program? eviCore made it easy to complete my primary task online. Pharmacy Prior Authorization eviCore Medical Oncology Drug List You will receive a letter in the mail and your physician will receive a letter via fax communicating this information. Member Rights Policy | Our hosts Dr. Torelli and Liz Avila are here to explain why. 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. eviCore intelliPath reflects eviCores commitment to modernize prior authorization and remove barriers to evidence-based care. endobj Review claim status and request claim adjustments. 5 0 obj E-Verify and IER Right to Work. services by chiropractors. If you are a Highmark network provider and have not signed up for NaviNet, learn how to do sohere. endobj wont be able to apply to eviCore openings. Q1: Overall, how satisfied are you with eviCores website? For Prior Authorization requests, use one of the following: CoverMyMeds: Website: CoverMyMeds.com (Preferred) Call: 1 (877) 813-5595 Member Rights Policy | All Rights Reserved. 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: 888-482-8057 Mon.-Fri., 8am - 11pm ET Sat., 8am - 3pm ET. The eviCore intelliPath. Watch the latest Auth the Cuff podcast featuring Dr. Sid Govindan and John Young. It speaks to the rapidly evolving healthcare industry, especially the increasing role of prior authorization and how providers can more effectively navigate it. Mailing address. Listen to our latest podcast episode with new host, Dr. Emily Coe featuring Dr. Mayank Shah. . Box 30757 Salt Lake City, UT 84130-0757 Payer ID#: 87726 (EDI claims submission) Pharmacy All Medicare authorization requests can be submitted using our general authorization form. The reality is, most providers weren't initially trained to deliver virtual care. of authorization request(s). The incredibly popular & eloquent nuclear stress test has been the subject of some recent studies on frequency. E-Verify and IER Right to Work. You may also go directly to eviCore's self-service web portal at www.evicore.com. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 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. endstream endobj 540 0 obj <. If you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request. Ethics & Compliance | I need to change the CPT code on my request. What additional tools are available as add-on programs to the Cardiovascular solution? As an alternative, call or fax these requests to eviCore at: Telephone: 1-855-774-1317 Fax: 1-800-540-2406 What will happen if the referring provider's office doesn't know the specific test code that needs to be ordered? 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, Prior authorization of a service is not a guarantee of payment of benefits. Register Now Thank you for using eviCores website today! With a PPO plan, you have the flexibility to seek care from doctors in and out of the network. Benefit plans vary widely and are subject to change based on the contract effective dates. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. Copyright 2022 eviCore healthcare. 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. 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. reCAPTCHA is not valid; Please try again! IMPORTANT: In the coming days, we will be migrating systems for our For additional resources on the Helion Arc authorization process, includinginstructionalvideos,CLICK HERE. eviCore intelliPath streamlines operations within a single easy-to-use application that integrates with major EHRs. You can request an expedited appeal by calling the prior authorization number for the plan that covers your patient. Dont I have to go to a hospital for my procedure? Use theAvailityProvider Portalor your preferred vendor to check eligibility and benefits before rendering services. 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. How does eviCore interact with radiology patients? A prior authorization isnota guarantee of benefits or payment. 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. 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. Member Rights Policy | If you have questions, call eviCore healthcare at . You might find that the answer is simpler than you think! E-Verify and IER Right to Work. 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. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status eviCore will communicate the determination utilizing the following methods: endstream endobj startxref Terms of Use | Receive support for technical or web portal related issue. 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 . For more specific contact information, choose the statement below that best represents you. Fax (24-hour) at 866-809-1370 . Ethics & Compliance | 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 new Auth the Cuff episode with eviCore's Dianne Doherty, Sr. 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. What is included in the Specialty Drug solution? Review claim status and request claim adjustments. eviCore made it easy to complete my primary task online. 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. Availity provides administrative services to BCBSIL.
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