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. Reminding and guiding patients to get the care they need. If you have questions, call eviCore healthcare at . 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. Federal Employee Program (FEP ) Verify eligibility and benefits and/or check claim status for FEP members. 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. Telehealth, Telemedicine Hologram Care? 2 0 obj How do I know when my test has been authorized? What are my options when a case is denied? 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). 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. Once a prior authorization request is received and processed, the decision is communicated to the provider. 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). eviCore intelliPath streamlines operations within a single easy-to-use application that integrates with major EHRs. The procedure codes contained in the lists below usually require authorization (based on the members benefit plan/eligibility). Why do we recommend conservative treatment options first? *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Please click here to register for an account. How does eviCore interact with radiology patients? 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 lookup tool. % 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). If you need preauthorization, contact eviCore in one of three ways: Get immediate approval by submitting your request at www.evicore.com. What do I tell my patient when their case is denied? For precertification, go online to eviCore.com or use the contact information below. If you do not remember your password, please click "Retrieve Password" below. Benefits > CHS Group Information" or call the prior authorization phone number on back of the member's ID card. Beginning Friday, December 18th at 5:00pm EST, you 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. MEDICAL POLICIES EmblemHealth Reduces Preauthoriz . If you do not hear back from us within 5 business days, please call, Please enter provider primary location address. Outpatient: 1-844-442-8012. I need to change the date on my request. The eviCore intelliPath. IMPORTANT: In the coming days, we will be migrating systems for our Annual Utilization Statistics | Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. Usually, the provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider. The terms of the members plan control the available benefits. Why didn't you call me the last time I had a procedure? 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. In keeping with DFS guidance, MetroPlusHealth's UM protocols resumed on June 22, 2020, including resuming issuing Prior Approvals and performing concurrent review. Fax 866-873-8279. 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. Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. 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. For more specific contact information, choose the statement below that best represents you. All Rights Reserved. 539 0 obj <> endobj Please click here to register for an account. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * All Rights Reserved. services by chiropractors. wont be able to apply to eviCore openings. To view this file, you may need to install a PDF reader program. Copyright 2022 eviCore healthcare. Electronic Data Interchange (EDI) Email: EDI@premera.com Fax all requests for services that require prior authorization to: Inpatient: 1-844-430-6806. hbbd```b`` {dd"Xdw&e7eu"j`RH2f@d\B;IH~ $4d? vI Note: Checking eligibility and benefits is key, butwe also have other resources to help you prepare. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Member Rights Policy | of authorization request(s). Register Now BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. Blue Cross and Blue Shield of Texas (BCBSTX) has contracted witheviCore healthcare (eviCore)*to provide certain utilization management prior authorization services for our government programs. Fax the request form to 888.647.6152. Part of it involves making sure the computer speaks the same language as the medical records. Tune into our latest Auth the Cuff podcast episode featuring pediatric oncologists Dr. Michelle Neier and Dr. Jessica Roberson, along with pediatric radiologist Dr. Keith Kronemer, who speak with Dr. Emily Coe on the impact COVID-19 has had, and may continue to have, on pediatric care. Terms of Use | How does eviCore communicate with the patients provider? This new site may be offered by a vendor or an independent third party. eviCore positions. What services are managed through the Musculoskeletal Therapies Program? This step will also help you determine if your services require prior authorization throughBCBSTXoreviCore. Thank you for using eviCores website today! 4. hb```|7@($qFqr&kX Q8rC%xd]ZG{5LA[K;:]*${;fR4kE[zGV@EFH;!Az. You're being redirected to the CMS search site. Q1: Overall, how satisfied are you with eviCores website? If the requested exam is denied, eviCore will notify both you and your physician and provide you with detailed appeal instructions. How does eviCore interact with Post-Acute Care patients? Were still hiring for other Manage practice information, access staff training and complete attestation requirements. Why would I switch to intelliPath ePA? *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Q1: Overall, how satisfied are you with eviCores website? You can fax your authorization request to 1-800-217-9345. PDF File is in portable document format (PDF). Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. What types of radiology procedures require prior authorization? eviCore.com. Preauthorization Lists New Empire Precertification Requ . 800.918.8924, For media inquiries please contactmedia@evicore.com. By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. Hospitals should contact CareAllies at (800) 227-9360 to obtain prior authorization. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. 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. In addition, peer-reviewed literature, major treatises, input from health plans, and practicing academic and community-based physicians are also utilized in the construction of our guidelines. Contact us Chat with us now. Hospital and Outpatient Services. Finally, eviCore manages select cardiology and radiology services for dates of service prior to Oct. 1, 2018, including postservice requests. eviCore currently maintains a nationwide advanced imaging network, featuring contracts with providers of imaging services in specific/predetermined locationsand as well as freestanding facilities. 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. Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST. For prior authorization requests handled by BCBSIL: There are two ways to initiate your request. Note: Most out-of-network services require utilization management review. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Introducing eviCores new podcast Auth the Cuff! Additional information about the programs and links to prior authorization codes are available under Care Management Programs in the left website menu. List. . 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, All Medicare authorization requests can be submitted using our general authorization form. What can chiropractic services do for my lower back pain? 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. Medical knowledge is doubling faster than ever, as are advances on insights to access and treatment options for medical oncology. Privacy Policy | Beginning Friday, December 18th at 5:00pm EST, you Eligibility Verification Providers should verify member eligibility prior to requesting/providing services. How did you get my phone number/information? endobj We already use the eviCore portal. Create an Account. 6 0 obj How does my doctor access the Specialty Drug Management solution? ", Chief of Radiology & SVP of Medical Affairs. In general, there arethreestepsprovidersshould follow. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status wont be able to apply to eviCore openings. "eviCore has over 1,100 doctors, therapists and nurses from a variety of specialties. Behavioral health. Privacy Policy | All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. What is the fastest way to do this? What is included in the Radiation Oncology program? What is included in the Radiology solution? we will be implementing changes to evicore.com in the near future. . eviCore will communicate the determination utilizing the following methods: Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. You will be contacted by an eviCore representative within 5 business days. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. Check status of submitted authorizations. Please click here to register for an account. 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. Use the link and toll-free phone number to access your training. 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! eviCore positions. 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. The site may also contain non-Medicare related information. Call Center: eviCore's is available from 7 a.m. to 7 p.m. The reality is, most providers weren't initially trained to deliver virtual care. In some instances repeat exams for condition treatment or management will require prior authorization. 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. %%EOF Specialized therapies such as chiropractic, acupuncture, and physical therapy are cost effective, and can provide improved outcomes for chronic pain patients. Check eligibility and benefits for members. endobj Member Rights Policy | All Requests: Utilize Authorization Inquiry function in NaviNet. As a result, eviCore helps reduce inappropriate utilization, unnecessary radiation exposure, and invasive procedures and thereby improves patient safety. Verify Member's ID Card At each visit, the oce should ask to see the member's ID card to verify eligibility and to collect the appropriate copayment. To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers Review claim status and request claim adjustments. Which EHRs does eviCores intelliPath ePA support? EmblemHealth Preauthorization List. 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. 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 Certain outpatient procedures, services, supplies. Emergency services are an exception. The incredibly popular & eloquent nuclear stress test has been the subject of some recent studies on frequency. eviCore interacts with radiology patients in two ways. wont be able to apply to eviCore openings. Sessions offered May and June. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. 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.
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