4. eviCores innovative SmartChoice program serves as a patient-outreach service that educateshealth plan members on available options for their advanced imaging procedure locations. 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. Driving Directions we will be implementing changes to evicore.com in the near future. % Copyright 2022 eviCore healthcare. Preauthorization Lists New Empire Precertification Requ . eviCore intelliPath . Call 1 (800) 88CIGNA (882-4462). Simply visit the eviCores Providers Hub page and select the health plan and solution option for your case in the training section. 4 0 obj Copyright 2022Health Care Service Corporation. 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. 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. We start off todays podcast talking about echocardiograms, one of the coolest tests ever. Refer to the Procedures that require authorization by eviCore healthcaredocument for more details. All Rights Reserved. 800.918.8924, For media inquiries please contactmedia@evicore.com. eviCore made it easy to complete my primary task online. Q4: How can eviCore make it easier for you to use this website? Contact your designated Independence Provider Network Services (PNS) team contact. Thank you for using eviCores website today! Telephone:For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. Prior authorization status can be viewed on demand via the eviCore portal at www.evicore.com or by calling eviCore at 866-220-3071. endstream In addition, some sites may require you to agree to their terms of use and privacy policy. If you have questions on a request handled by AIM or eviCore, call the appropriate vendor, as noted above. Learn more about the life-interrupting issue of back pain, and the long-term benefits of saving surgery for a last resort. 1 0 obj . What types of radiology procedures require prior authorization? In this weeks podcast, Dr. Torelli and Liz Avila discuss why its important for all patients to learn more about their care. Copyright 2022 eviCore healthcare. . Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. What do I tell my patient when their case is denied? In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. Website: eviCore.com Phone: 888.693.3297 (7:00 am-7:00 pm local time) Fax: 888.693.3210 Important notes You can generally determine if a customer's plan requires precertification for these services by looking for "Outpatient Procedures" on the back of their Cigna ID card. Receive support for technical or web portal related issue. All Rights Reserved. Fax the request form to 888.647.6152. External link You are leaving this website/app (site). 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, Thank you for using eviCores website today! Second, when requests reach a final status, the patient receives a letter indicating whether the request has been approved or denied. we will be implementing changes to evicore.com in the near future. The list applies to the following EmblemHealth lines of business: GHI Commercial non-City of New York. Please click here to register for an account. The provider is responsible for verification of member eligibility and covered benefits. For many services, we manage the precertification process directly. Prior authorization of a service is not a guarantee of payment of benefits. 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. 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, Q4: How can eviCore make it easier for you to use this website? Finally, eviCore manages select cardiology and radiology services for dates of service prior to Oct. 1, 2018, including postservice requests. IMPORTANT: In the coming days, we will be migrating systems for our Check Status of Existing Prior Authorization. To request any additional assistance in accessing the guidelines, . Inpatient Planned Requests: Call Highmark Clinical Services; Press 2 for authorization requirements/ status. Thank you for using eviCores website today! I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? we will be implementing changes to evicore.com in the near future. Simply, notify HAP within 48 hours of the emergency admission. Intake form. With a PPO plan, you have the flexibility to seek care from doctors in and out of the network. 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). Utilization Management. eviCore interacts with radiology patients in two ways. 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. Hospital and Outpatient Services. Should I reschedule? Ethics & Compliance | Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 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 field of gastroenterology is evolving. How do I obtain clinical certification for cardiovascular tests? This podcast was created with the providers in mind. For inpatient hospital stays, your doctor will get prior authorization from HAP. eviCore made it easy to complete my primary task online. 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. 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. 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). Forgot Password? Report concerns to the BCBSIL Special Investigations Department (SID) Fraud website 1 . Clinical Resourcespage on theBCBSTX Medicaidwebsite. information about accessing the eviCore portal. What can chiropractic services do for my lower back pain? %%EOF The site may also contain non-Medicare related information. Online - The eviCore Web Portal is available 24x7. jandbmedical.com. wont be able to apply to eviCore openings. Please use the BCBSAZ MA prior authorization fax form or the eviCore online request tool, available on the secure MA . Terms of Use | Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. Examples of services that may require authorization include the following. I got a message from a SmartChoice representative asking me to call back; why are you calling me? 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: You will receive a letter in the mail and your physician will receive a letter via fax communicating this information. Available Trainings eviCore periodically will host orientation sessions for providers for various care categories. What is included in the Medical Oncology program? I need to change the CPT code on my request. Review claim status and request claim adjustments. Register Now Some procedures may also receive instant approval. 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. Listen to our latest podcast episode with new host, Dr. Emily Coe featuring Dr. Mayank Shah. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Please utilize our live chat feature which is available 7AM-7PM EST M-F. By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. Copyright 2022 eviCore healthcare. Q4: How can eviCore make it easier for you to use this website? 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 . Report Fraud & Abuse | Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status In practice, utilization management plays a large role in patient safety and empowerment. Certain employer groups may require prior authorization or pre-notification through other vendors. Continue to Authorization Lookup Login Log In Forgot User ID? How did you get my phone number/information? Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. GHI Medicare non-City of New York. All Rights Reserved. Do you offer a mandatory prior authorization program for all sleep studies? If the provider or member doesnt get prior authorization for out-of-network services, the claim may be denied. Contact J&B at 1-888-896-6233 or . Q1: Overall, how satisfied are you with eviCores website? Medical knowledge is doubling faster than ever, as are advances on insights to access and treatment options for medical oncology. open positions so continue your job search at Cigna.com/careers. E-Verify and IER Right to Work. eviCore.com 1-855-252-1117. Continue to Authorization Lookup Login Log In Forgot User ID? 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, eviCores approach is not to deny care that is needed but rather to redirect providers and patients to more appropriate testing and treatment options, which helps ensure safety and maximize value. Copyright 2022 eviCore healthcare. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status How does eviCore interact with radiology patients? What types of cardiovascular procedures require prior authorization? we will be implementing changes to evicore.com in the near future. Multi-Factor Authentication (MFA) is now live on eviCores web portal! Some authorization requirements vary by member contract. EmblemHealth Reduces Preauthoriz . Availity provides administrative services to BCBSIL. [{"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. 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, 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). Do you ever ask the question about why you might need that MRI or CT scan? 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 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. Note: Checking eligibility and benefits is key, butwe also have other resources to help you prepare. 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. endstream endobj startxref Annual Utilization Statistics | Why do we recommend conservative treatment options first? GEHA, like other federal medical plans, requires providers to obtain authorization before some services and procedures are performed. 5 0 obj Apr 06, 2023. 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. 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. What if the request does not meet clinical criteria? Behavioral health. Part of it involves making sure the computer speaks the same language as the medical records. How does eviCore handle large gene panels? of authorization request(s). Prior authorization is required by eviCore healthcare for services performed for adult Bluffton, SC 29910 Member Rights Policy | ** Exception: Diabetic shoes and inserts are handled by Northwood, Inc . of authorization request(s). E-Verify and IER Right to Work. 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 . All Rights Reserved. Specialized therapies such as chiropractic, acupuncture, and physical therapy are cost effective, and can provide improved outcomes for chronic pain patients. Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. PPO members You don't need to worry about referrals. Highmark recently launched the Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. If urgent (after-hours) call 866-322-6287 , from 9 p.m. to 9 a.m., Monday through Friday. E-Verify and IER Right to Work. 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. Thank you for using eviCores website today! eviCore made it easy to complete my primary task online. Copyright 2022 eviCore healthcare. Our hosts Dr. Torelli and Liz Avila are here to explain why. How does eviCore communicate with the patients provider? wont be able to apply to eviCore openings. 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. This step will also help you determine if your services require prior authorization throughBCBSTXoreviCore. What is included in the Specialty Drug solution? reCAPTCHA is not valid; Please try again! To view this file, you may need to install a PDF reader program. If you have any questions about this notice, please the Prior Authorization Department at (646) 473-7446. Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. Manager, Network Quality Assurance, Anne McLead, Sr. Director, Network Operations and Christa Gassler, Sr. Director, Affordability SoC, to learn how our site of care program advocates for clients and their covered members, how we identify high-quality freestanding imaging centers, negotiate costs for direct savings, and more. If you have questions, call eviCore healthcare at . The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. Outpatient: 1-844-442-8012. Check eligibility and benefits for members. I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? CareCore National Web Portal Friday, April 28, 2023 10:41 AM For log in problems: Please try the email address that you registered with as your user name. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * eviCore positions. Information for Blue Cross and Blue Shield of Illinois (BCBSIL) members is found onour member site. eviCore positions. This is not an all-inclusive list. Most PDF readers are a free download. Many changes will take effect \u003cstrong\u003eJuly 6, 2023\u003c/strong\u003e. Always check eligibility and benefits first,via theAvailityEssentialsor your preferred web vendor, prior to rendering care and services. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization. Effective May 1, 2023, AmeriHealth Caritas North Carolina (ACNC) will require prior authorization via eviCore healthcare for selected health care services. Why would I switch to intelliPath ePA? 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. reCAPTCHA is not valid; Please try again! 0 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. Visit www.evicore.com Call 800.533.1206 Monday - Friday: 7:00 a.m. to 7:00 p.m. we will be implementing changes to evicore.com in the near future. How does eviCore interact with providers? How does eviCore interact with Post-Acute Care patients? 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. 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. Please click here to register for an account. What can physical therapy do for my lower back pain? endstream endobj 540 0 obj <. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Authorizations for HDHP, Standard and High Option members Most PDF readers are a free download. EmblemHealth Preauthorization List. E-Verify and IER Right to Work. What do I do if a members eligibility is incorrect or not on file? reCAPTCHA is not valid; Please try again! Benefits > CHS Group Information" or call the prior authorization phone number on back of the member's ID card.