Refer to the Procedures that require authorization by eviCore healthcaredocument for more details. The site may also contain non-Medicare related information. Learn more from eviCore experts Sid Govindan, MD and John Young on how eviCore is applying these technologies to evolve the prior authorization process. Federal Employee Program (FEP ) Verify eligibility and benefits and/or check claim status for FEP members. I need to change the date on my request. 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 In some instances repeat exams for condition treatment or management will require prior authorization. Review claim status and request claim adjustments. This information is intended to serve as a reference summary that outlines where information about Highmarks authorization requirements can be found. How do I obtain clinical certification for cardiovascular tests? E-Verify and IER Right to Work. You're being redirected to the CMS search site. Prior authorization lookup tool. If the provider or member doesnt get prior authorization for out-of-network services, the claim may be denied. How does eviCore interact with providers? Why was my test, treatment, or procedures not approved? Intake form. 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. endstream endobj startxref Tune into our new Auth the Cuff episode with eviCore's Dianne Doherty, Sr. What claims are subject to claims review? If you have questions on a request handled by AIM or eviCore, call the appropriate vendor, as noted above. Ethics & Compliance | wont be able to apply to eviCore openings. The site may also contain non-Medicare related information. eviCore made it easy to complete my primary task online. Fax (24-hour) at 866-809-1370 . Report Fraud & Abuse | open positions so continue your job search at Cigna.com/careers. of authorization request(s). Annual Utilization Statistics | In addition, they face growing administrative burdens. Most PDF readers are a free download. You can verify benefits and request prior authorization at Availity.com or by phone at 1-888-693-3211 1-888-693-3211. Additional information on authorizations can be found in Chapter 5 (Care & Quality Management) of the Highmark Provider Manual. The authorization is typically obtained by the ordering provider. 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. open positions so continue your job search at Cigna.com/careers. Electronic Data Interchange (EDI) Email: EDI@premera.com Inpatient Planned Requests: Call Highmark Clinical Services; Press 2 for authorization requirements/ status. 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. 400 Buckwalter Place Blvd. endstream How do I obtain clinical certification for radiology tests? Telephone:For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. Member Rights Policy | reCAPTCHA is not valid; Please try again! So how do we continue to think about best practices for telehealth? Forgot Password? 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. Most PDF readers are a free download. Their sole job is to ensure patients get the best possible care. How does eviCore communicate with the patients 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. For inpatient hospital stays, your doctor will get prior authorization from HAP. How will prior authorization determinations be communicated? You may also go directly to eviCore's self-service web portal at www.evicore.com. As part of our continued effort to provide a high quality user experience while also ensuring the integrity of the information of those that we service is protected, Annual Utilization Statistics | wont be able to apply to eviCore openings. The procedure codes contained in the lists below usually require authorization (based on the members benefit plan/eligibility). Radiation Therapy: Call: 1 (866) 686-4452 . 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. What do I tell my patient when their case is denied? Report concerns to the BCBSIL Special Investigations Department (SID) Fraud website 1 . Call Utilization Management at 855-339-8127, 9 a.m to 9 pm., Monday through Friday. 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. endstream endobj 540 0 obj <. Member Rights Policy | For additional resources on the Helion Arc authorization process, includinginstructionalvideos,CLICK HERE. Mailing address. What types of radiology procedures require prior authorization? Copyright 2022 eviCore healthcare. Some requests are handled by BCBSIL; others are handled by utilization management vendors. Eligibility Verification Providers should verify member eligibility prior to requesting/providing services. 1-888-693-3211 (TTY: 711). . Check eligibility and benefits for members. 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. 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). hbbd```b`` {dd"Xdw&e7eu"j`RH2f@d\B;IH~ eviCore healthcare (eviCore) is an independent company that has contracted with BCBSIL to provide prior authorization for expanded outpatient and specialty utilization management for members with coverage through BCBSIL. E-Verify and IER Right to Work. 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. 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 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 Phone - Call eviCore toll-free at 855-252-1117 . ", Chief of Radiology & SVP of Medical Affairs. 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. Frequently asked questions about requesting authorization from eviCore healthcare It speaks to the rapidly evolving healthcare industry, especially the increasing role of prior authorization and how providers can more effectively navigate it. All web users may now protect their portal accounts with an additional layer of security, including e-mail & SMS. The diagnostic exams requiring prior authorization generally include the following procedures*: *prior authorization of certain procedures can vary by health plan. Privacy Policy | Available Trainings eviCore periodically will host orientation sessions for providers for various care categories. Prior authorization status can be viewed on demand via the eviCore portal at www.evicore.com or by calling eviCore at 866-220-3071. Our hosts Dr. Torelli and Liz Avila are here to explain why. How does a provider check the prior authorization status for a member? Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. Beginning Friday, December 18th at 5:00pm EST, you With a PPO plan, you have the flexibility to seek care from doctors in and out of the network. Annual Utilization Statistics | Please click here to register for an account. Were still hiring for other Prior Authorizations. How do I know when my test has been authorized? <>>>/BBox[ 0 0 576 201.59] /Matrix[ 0.125 0 0 0.35716 0 0] /Filter/FlateDecode/Length 7100>> The field of gastroenterology is evolving. Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) prior to performing the procedure or service. 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. Utilization Management. As a result, eviCore helps reduce inappropriate utilization, unnecessary radiation exposure, and invasive procedures and thereby improves patient safety. 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. In addition, some sites may require you to agree to their terms of use and privacy policy. Our proprietary integrated system, Claims Studio, delivers savings through an enhanced focus on accurate claims payment. To view this file, you may need to install a PDF reader program. Prior authorization isrequiredfor some members/services/drugsbefore services are rendered to confirm medical necessity as defined by the members health benefit plan. GHI Medicare non-City of New York. Introducing eviCores new podcast Auth the Cuff! Outpatient: 1-844-442-8012. My procedure is scheduled soon and I havent heard if my case is approved or not. What digital resources can I access to find out more information? Services billed with the following revenue codes always require prior authorization: 0240-0249 All-inclusive ancillary psychiatric. Review claim status and request claim adjustments. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Watch this weeks episode of Auth the Cuff to learn more! <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Or . All Rights Reserved. What additional tools are available as add-on programs to the Radiology solution? An eviCore representative will review the information submitted to determine the next level of review for this request. Privacy Policy | 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 status of submitted authorizations. If you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request. The eviCore intelliPath. hb```|7@($qFqr&kX Q8rC%xd]ZG{5LA[K;:]*${;fR4kE[zGV@EFH;!Az. 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. Finally, eviCore manages select cardiology and radiology services for dates of service prior to Oct. 1, 2018, including postservice requests. I need to change the CPT code on my request. Beginning Friday, December 18th at 5:00pm EST, you Find Contact Information; Podcasts; GO TO PROVIDER'S HUB. 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. eviCore made it easy to complete my primary task online. [{"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. Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status In keeping with DFS guidance, MetroPlusHealth's UM protocols resumed on June 22, 2020, including resuming issuing Prior Approvals and performing concurrent review. 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. Fraud Hotline. GEHA, like other federal medical plans, requires providers to obtain authorization before some services and procedures are performed. Beginning Friday, December 18th at 5:00pm EST, you MCG Clinical Criteria- Information on Highmark's incorporation of MCG Health evidence-based clinical guidelines into Highmarks criteria of clinical decision support. All Rights Reserved. Benefits can vary; always confirm member coverage. One option is Adobe Reader which has a built-in reader. 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. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * reCAPTCHA is not valid; Please try again! Register Now Please retain the confirmation email. Providers who do not have NaviNet,can use the HIPAA Health Services Review (278) electronic transactions for some types of authorizations. . A prior authorization isnota guarantee of benefits or payment. endobj Prior authorization of a service is not a guarantee of payment of benefits. To view this file, you may need to install a PDF reader program. <> If the requested exam is denied, eviCore will notify both you and your physician and provide you with detailed appeal instructions. 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. Directory Who to Contact for Preauthorization All providers must verify member eligibility and benefits prior to rendering non-emergency services. Care Management Programs Report Fraud & Abuse | endobj eviCore positions. eviCore made it easy to complete my primary task online. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. How does a computer make healthcare decisions? Benefits > CHS Group Information" or call the prior authorization phone number on back of the member's ID card. View fee schedules, policies, and guidelines. 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. What is included in the Radiation Oncology program? What do I do if a members eligibility is incorrect or not on file? of authorization request(s). BCBSAZ Health Choice requires all non-contracted dentists to obtain a Prior Authorization before rendering treatment. Second, when requests reach a final status, the patient receives a letter indicating whether the request has been approved or denied. services by chiropractors. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. If you have any questions about this notice, please the Prior Authorization Department at (646) 473-7446. reCAPTCHA is not valid; Please try again! Registration, user access/ account assistance, portal navigation, error message understanding. of authorization request(s). Participating providers can find more precertification phone numbers in Participating provider precertification list for Aetna (PDF). Telehealth, Telemedicine Hologram Care? eviCore made it easy to complete my primary task online. of authorization request(s). Were still hiring for other What can physical therapy do for my lower back pain? In addition, some sites may require you to agree to their terms of use and privacy policy. In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. Thank you for using eviCores website today! . we will be implementing changes to evicore.com in the near future. In general, there arethreestepsprovidersshould follow. Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status If you need preauthorization, contact eviCore in one of three ways: Get immediate approval by submitting your request at www.evicore.com. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. Why is eviCore providing intelliPath ePA free of charge for eviCore-managed lives? 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? For Prior Authorization requests, use one of the following: CoverMyMeds: Website: CoverMyMeds.com (Preferred) Call: 1 (877) 813-5595 Preauthorization Lists New Empire Precertification Requ . BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. <> open positions so continue your job search at Cigna.com/careers, Something went wrong.Please try again after some time, Thank you for submitting. Meet Dr. Scarborough, Chief of Radiology & SVP of Medical Affairs. Provider costs are reduced and decisions are communicated in real time, reducing delays. What if the request does not meet clinical criteria? 539 0 obj <> endobj 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. If you have questions, call eviCore healthcare at . 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. 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 Annual Utilization Statistics | Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST. 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. 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! Medical knowledge is doubling faster than ever, as are advances on insights to access and treatment options for medical oncology. Usually, the provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider. 6 0 obj Prior authorization is required by eviCore healthcare for services performed for adult :|gx7e#FB|+9?{RX7:!m$wCrrra4Ok2gfMrTsw Please click here to register for an account. See Clinical Corner for services that require Preauthorization. Please click here to register for an account. 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. 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). eviCore positions. Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. 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. External link You are leaving this website/app (site). Additional information on authorizations can be found in Chapter 5 (Care & Quality Management) of the Highmark Provider Manual. The list applies to the following EmblemHealth lines of business: GHI Commercial non-City of New York. Please utilize our live chat feature which is available 7AM-7PM EST M-F. 1-800-624-0756 (TTY: 711) for HMO and Medicare Advantage benefits plans. PNS contact tool. Were still hiring for other Behavioral health. Create an Account. Continue to Authorization Lookup Login Log In Forgot User ID? Please click here to register for an account. 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. PROVIDERS AREA. It indicates which codes are handled by a vendor. Beginning Friday, December 18th at 5:00pm EST, you To request any additional assistance in accessing the guidelines, . You can also see eviCore healthcare's criteria and get request forms at . Privacy Policy | 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. eviCoreis an independent company that provides specialty medical benefits management for BCBSTX. Moreover, eviCore is the only company in the industry with dedicated, separately maintained pediatric guidelines. eviCore intelliPath streamlines operations within a single easy-to-use application that integrates with major EHRs. Contact Us; Search. Examples of services that may require authorization include the following. % Beginning Friday, December 18th at 5:00pm EST, you endobj 0 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. For more information about prior authorization, please review Mercy Care's Provider Manuals located under the Provider Information tab on our website. 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. 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 . Copyright 2022 eviCore healthcare. endobj Always check eligibility and benefits first,via theAvailityEssentialsor your preferred web vendor, prior to rendering care and services. Our network of quality providers offers an attractive option for health plansseeking to more appropriately manage radiology benefits. Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, CAR-T Cell Therapy & Medical Oncology Disparities, Crunching the Numbers! I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? Service preapproval is based on the members benefit plan/eligibility at the time the service is reviewed/approved. Q4: How can eviCore make it easier for you to use this website? The terms of the members plan control the available benefits.
