External link You are leaving this website/app (site). eviCore made it easy to complete my primary task online. Why is eviCore providing intelliPath ePA free of charge for eviCore-managed lives? Please click here to register for 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, BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. eviCore positions. wont be able to apply to eviCore openings. Step 1 Confirm if Prior Authorization is Required. Thank you for using eviCores website today! <>>>/BBox[ 0 0 576 201.59] /Matrix[ 0.125 0 0 0.35716 0 0] /Filter/FlateDecode/Length 7100>> BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. Which EHRs does eviCores intelliPath ePA support? Providers who do not have NaviNet,can use the HIPAA Health Services Review (278) electronic transactions for some types of authorizations. Click herefor the MFA registration & setup guide. Beginning Friday, December 18th at 5:00pm EST, you 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. we will be implementing changes to evicore.com in the near future. Member Rights Policy | open positions so continue your job search at Cigna.com/careers. Register Now <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> This information is intended to serve as a reference summary that outlines where information about Highmarks authorization requirements can be found. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. Effective 10/13/2017 - 12/31/2020. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Why do we recommend conservative treatment options first? It speaks to the rapidly evolving healthcare industry, especially the increasing role of prior authorization and how providers can more effectively navigate it. eviCore made it easy to complete my primary task online. If you are a Highmark network provider and have not signed up for NaviNet, learn how to do sohere. What is the fastest way to do this? IMPORTANT: In the coming days, we will be migrating systems for our Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Introducing eviCores new podcast Auth the Cuff! Thank you for using eviCores website today! Portal:The preferred - and fastest - method to submit preauthorization requests and receive approvals isNaviNet. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). This new site may be offered by a vendor or an independent third party. eviCore made it easy to complete my primary task online. Annual Utilization Statistics | Privacy Policy | eviCore.com 1-855-252-1117. Were still hiring for other I need to change the CPT code on my request. Why would I switch to intelliPath ePA? 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. What is the fastest way to do this? 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. E-Verify and IER Right to Work. 1 0 obj we will be implementing changes to evicore.com in the near future. wont be able to apply to eviCore openings. Note: Most out-of-network services require utilization management review. Electronic Data Interchange (EDI) Email: EDI@premera.com 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. 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. IMPORTANT: In the coming days, we will be migrating systems for our endobj How does eviCore interact with Post-Acute Care patients? of authorization request(s). All Rights Reserved. Were still hiring for other Privacy Policy | Effective dates are subject to change. 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. IMPORTANT: In the coming days, we will be migrating systems for our Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. 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. x]$9n7P&zK_0wv/"}Rla@hT_RIQD*;R{|Gvg|\~I%_)u. 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. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. Ethics & Compliance | E-Verify and IER Right to Work. So how do we continue to think about best practices for telehealth? You will receive a letter in the mail and your physician will receive a letter via fax communicating this information. Some procedures may also receive instant approval. You may also go directly to eviCore's self-service web portal at www.evicore.com. 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. open positions so continue your job search at Cigna.com/careers. Specialized therapies such as chiropractic, acupuncture, and physical therapy are cost effective, and can provide improved outcomes for chronic pain patients. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. PDF File is in portable document format (PDF). Copyright 2022 eviCore healthcare. reCAPTCHA is not valid; Please try again! 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? Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. reCAPTCHA is not valid; Please try again! Usually, the provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider. 1-800-972-8382. Report concerns to the BCBSIL Special Investigations Department (SID) Fraud website 1 . 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. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Contact Us; Search. For Prior Authorization requests, use one of the following: CoverMyMeds: Website: CoverMyMeds.com (Preferred) Call: 1 (877) 813-5595 . We recognize that providers today navigate a complicated healthcare system while trying to make the best medical decisions for their patients. The eviCore intelliPath. Simply, notify HAP within 48 hours of the emergency admission. jandbmedical.com. What services are managed through the Musculoskeletal Therapies Program? Please check directly with your health plan for specific requirements or contact eviCores Customer Service at (800) 918-8924. Annual Utilization Statistics | Benefits > CHS Group Information" or call the prior authorization phone number on back of the member's ID card. Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. What is included in the Radiation Oncology program? What types of cardiovascular procedures require prior authorization? Many changes will take effect \u003cstrong\u003eJuly 6, 2023\u003c/strong\u003e. Call 1 (800) 88CIGNA (882-4462). Annual Utilization Statistics | Portal Login Insights Blog eviCore Colorectal Screening Program Sessions offered May and June. eviCore made it easy to complete my primary task online. ** Exception: Diabetic shoes and inserts are handled by Northwood, Inc . we will be implementing changes to evicore.com in the near future. we will be implementing changes to evicore.com in the near future. The site may also contain non-Medicare related information. 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. Listen to the new Auth the Cuff podcast for more information. Behavioral health. . What do I do if a members eligibility is incorrect or not on file? To viewrequirements summaries andprocedure code lists, refer to theSupport Materials (Commercial)andSupport Materials (Government Programs)pages. Member Rights Policy | 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. 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. The provider is responsible for verification of member eligibility and covered benefits. The site may also contain non-Medicare related information. of authorization request(s). eviCores evidence-based Radiology Clinical guidelines are based upon major national and international association and society guidelines and criteria. Telephone:For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. Driving Directions I agree to HIPAA Disclosure Remember User ID LOGIN Don't have 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. Report Fraud & Abuse | Services billed with the following revenue codes always require prior authorization: 0240-0249 All-inclusive ancillary psychiatric. Q4: How can eviCore make it easier for you to use this website? Please click here to register for an account. The list applies to the following EmblemHealth lines of business: GHI Commercial non-City of New York. All Rights Reserved. Our network of quality providers offers an attractive option for health plansseeking to more appropriately manage radiology benefits. I need to change the date on my request. Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Additional information on authorizations can be found in Chapter 5 (Care & Quality Management) of the Highmark Provider Manual. MEDICAL POLICIES 1-800-624-0756 (TTY: 711) for HMO and Medicare Advantage benefits plans. Thank you for using eviCores website today! You can also see eviCore healthcare's criteria and get request forms at . open positions so continue your job search at Cigna.com/careers. 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. Check eligibility and benefits for members. eviCore positions. Registration, user access/ account assistance, portal navigation, error message understanding. 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 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. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status In addition, some sites may require you to agree to their terms of use and privacy policy. While very useful when used appropriately, these studies have established some new guidelines to follow around this important test. To contact Customer Care, please call the phone number on the back of your Member ID Card. Examples of services that may require authorization include the following. Emergency services are an exception. How does eviCore communicate with the patients provider? Second, when requests reach a final status, the patient receives a letter indicating whether the request has been approved or denied. 888-482-8057 Mon.-Fri., 8am - 11pm ET Sat., 8am - 3pm ET. Some authorization requirements vary by member contract. What is included in the Radiology solution? All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. 4. . Prior authorization of a service is not a guarantee of payment of benefits. Moreover, eviCore is the only company in the industry with dedicated, separately maintained pediatric guidelines. What if the request does not meet clinical criteria? There are three ways to submit requests to eviCore healthcare for outpatient diagnostic imaging procedures: Contact them via phone at 1-888-693-3211 Monday through Friday between 8 a.m. and 9 p.m. EST. Remember, member benefits and review requirements will vary based on service/drug being rendered and individual/group policy elections. Reminding and guiding patients to get the care they need. If you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request. To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 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. eviCoreis an independent company that provides specialty medical benefits management for BCBSTX. As a valued user of our website, we'd appreciate your feedback to help us improve your website experience. Copyright 2022 eviCore healthcare. Emergency room visits don't require prior authorization. Check eligibility and benefits for members. Call 1-888-233-8158 from 8:00 a.m. to 9:00 p.m., Eastern, Monday through Friday. % In this weeks podcast, Dr. Torelli and Liz Avila discuss why its important for all patients to learn more about their care. Most PDF readers are a free download. of authorization request(s). endstream 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. Availity Essentials, Essentials Plus, or EDI Clearinghouse Customers: If you have an Availity Essentials, Essentials Plus, or EDI Clearinghouse account and cannot log in to submit a ticket, call 1-800-282-4548 for support. The Member Customer Care Center is open Monday-Friday, 8 am to 6 pm (ET). Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Certain employer groups may require prior authorization or pre-notification through other vendors. 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. EmblemHealth Reduces Preauthoriz . Bluffton, SC 29910 I agree to HIPAA Disclosure Remember User ID LOGIN Don't have 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. 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: Were still hiring for other Report Fraud & Abuse | Copyright 2022 eviCore healthcare. BCBSAZ-TPA co-administered plans (prefixes K8Y, K8Z, and NBT) . Providers and/or staff can request prior authorization and make revisions to existing cases by calling 1-866-496-6200. Medical Oncology: Call: 1 (866) 668-9250 Fax: 1 (800) 540-2406. Annual Utilization Statistics | With a PPO plan, you have the flexibility to seek care from doctors in and out of the network. All Rights Reserved. Q1: Overall, how satisfied are you with eviCores website? Annual Utilization Statistics | Were still hiring for other *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * hbbd```b`` {dd"Xdw&e7eu"j`RH2f@d\B;IH~ 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. endobj Prior Authorizations. 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). E-Verify and IER Right to Work. \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). Description. Report Fraud & Abuse | Refer to the March 30, 2023, provider notice (PDF) for more information and to register for training based on your physicians specialty. Forgot Password? Finally, eviCore manages select cardiology and radiology services for dates of service prior to Oct. 1, 2018, including postservice requests. Ethics & Compliance | Radiation Therapy: Call: 1 (866) 686-4452 . Trials, Treatments, and Oncology Breakthroughs, Check Status of Existing Prior Authorization. Online - The eviCore Web Portal is available 24x7. This is not an all-inclusive list. Todays Auth the Cuff podcast is talking really high-tech: artificial intelligence, natural language processing, statistical modeling, oh my! 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, Benefits can vary; always confirm member coverage. wont be able to apply to eviCore openings. Utilization Management (Prior Authorizations), STAR Kids Referral and Authorization Process, Value-Added Services for STAR, CHIP and STAR Kids, Medicaid Provider Information on COVID-19 Coverage, Quality Improvements (QI) Toolkits and Tip Sheets, Home Delivery Pharmacy (Mail-Order Pharmacy), Medicaid (STAR) and CHIP Prior Authorization Forms. All web users may now protect their portal accounts with an additional layer of security, including e-mail & SMS. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Multi-Factor Authentication (MFA) is now live on eviCores web portal! Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. 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. <>>> 539 0 obj <> endobj *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * eviCore positions. Member Rights Policy | Thank you for using eviCores website today! Please click here to register for an account. 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). How does eviCore handle large gene panels? Continue to Authorization Lookup Login Log In Forgot User ID? Provider Education -We interact with providers during implementation and on an ongoing basis to render support and educational resources, as well as obtain feedback for solution improvements. 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). Bonus! 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. Why didn't you call me the last time I had a procedure? By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. The instructions on how to submit a case and a link to the correct portal to use will be provided. Frequently asked questions about requesting authorization from eviCore healthcare * eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSTX. As a result, eviCore helps reduce inappropriate utilization, unnecessary radiation exposure, and invasive procedures and thereby improves patient safety. View fee schedules, policies, and guidelines. Step 2If prior authorization is required, have the following information ready: Step 3 Submit Your Prior Authorization Request. Echocardiograms also just so happen to be one of the most common inappropriately ordered tests. Tune into our new Auth the Cuff episode with eviCore's Dianne Doherty, Sr. The incredibly popular & eloquent nuclear stress test has been the subject of some recent studies on frequency. EmblemHealth Preauthorization List. In addition, they face growing administrative burdens. 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. It indicates which codes are handled by a vendor. eviCore supports Choosing Wisely (www.choosingwisely.org), an initiative maintained by the American Board of Internal Medicine (ABIM) Foundation and many national physician organizations, to reduce the overuse of diagnostic tests that are of marginal or no value, or whose risks are greater than their benefits. Always check eligibility and benefits first,via theAvailityEssentialsor your preferred web vendor, prior to rendering care and services. There is a notion of utilization management being solely focused on cost savings. ** Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. What types of radiology procedures require prior authorization? For inpatient hospital stays, your doctor will get prior authorization from HAP. Box 30757 Salt Lake City, UT 84130-0757 Payer ID#: 87726 (EDI claims submission) Pharmacy Most PDF readers are a free download. If you do not remember your password, please click "Retrieve Password" below. Please use the BCBSAZ MA prior authorization fax form or the eviCore online request tool, available on the secure MA . Privacy Policy | 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. Lab Prior Authorization CPT Code List. In general, there arethreestepsprovidersshould follow. Contact J&B at 1-888-896-6233 or . of authorization request(s). Some requests are handled by BCBSIL; others are handled by utilization management vendors. %PDF-1.6 % Mailing address. Inpatient Planned Requests: Call Highmark Clinical Services; Press 2 for authorization requirements/ status. Please retain the confirmation email. 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 list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. Where are Musculoskeletal Program guidelines and how are they accessed? What can physical therapy do for my lower back pain? reCAPTCHA is not valid; Please try again! You are leaving this website/app (site). Online forms from eviCore's carriers hub MENU PROVIDERS About; Solutions. The terms of the members plan control the available benefits. Call Utilization Management at 855-339-8127, 9 a.m to 9 pm., Monday through Friday. All Rights Reserved. Simply visit the eviCores Providers Hub page and select the health plan and solution option for your case in the training section.

Cryptophasia Examples, Articles E