What do I tell my patient when their case is denied? information about accessing the eviCore portal. Box 30757 Salt Lake City, UT 84130-0757 Payer ID#: 87726 (EDI claims submission) Pharmacy Prior authorization is required by Carelon Medical Benefits Management (formerly AIM . All Rights Reserved. Pre-authorization - Regence Q1: Overall, how satisfied are you with eviCores website? What is the fastest way to do this? The authorization is typically obtained by the ordering provider. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * wont be able to apply to eviCore openings. In this weeks podcast, Dr. Torelli and Liz Avila discuss why its important for all patients to learn more about their care. 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. wont be able to apply to eviCore openings. ** Exception: Diabetic shoes and inserts are handled by Northwood, Inc . BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. Why was my test, treatment, or procedures not approved? All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. Why would I switch to intelliPath ePA? Additional information about the programs and links to prior authorization codes are available under Care Management Programs in the left website menu. Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. Why didn't you call me the last time I had a procedure? The "Live Sessions" page will display. 6 0 obj eviCore Prior Authorization Program | Blue Cross and Blue - BCBSTX What additional tools are available as add-on programs to the Cardiovascular solution? 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. Dr. Torelli and Liz Avila are back today discussing the growing issue of rising healthcare costs. Find Contact Information; Podcasts; GO TO PROVIDER'S HUB. Contact Support | eviCore Support 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. Available Trainings eviCore periodically will host orientation sessions for providers for various care categories. To view this file, you may need to install a PDF reader program. Member Rights Policy | Use the link and toll-free phone number to access your training. Thank you for using eviCores website today! If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. What additional tools are available as add-on programs to the Radiology solution? What do I do if a members eligibility is incorrect or not on file? We offer providers ongoing touch-pointsthat include a team dedicated to on-site visits; professional surveys; and the rigorous tracking and receiving of feedback from both providers and our clients. Request Prior Authorization and Check Status Online via Provider Access Online Forms | Providers Hub | eviCore - Prior Authorizations You can verify benefits and request prior authorization at Availity.com or by phone at 1-888-693-3211 1-888-693-3211. Do you ever ask the question about why you might need that MRI or CT scan? Reminding and guiding patients to get the care they need. Please click here to register for an account. 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 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. Bonus! Effective dates are subject to change. Preauthorization Lists New Empire Precertification Requ . Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. The list applies to the following EmblemHealth lines of business: GHI Commercial non-City of New York. Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) prior to performing the procedure or service. 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, Q1: Overall, how satisfied are you with eviCores website? Q1: Overall, how satisfied are you with eviCores website? Check eligibility and benefits for members. Fax the request form to 888.647.6152. From cultural moments, to utilization management, capsule endoscopy technology advancements, and more. Health Plans. I got a message from a SmartChoice representative asking me to call back; why are you calling me? You are leaving this website/app (site). 1-888-MDAETNA (1-888-632-3862) (TTY: 711) for all other plans. eviCore made it easy to complete my primary task online. If the provider or member doesnt get prior authorization for out-of-network services, the claim may be denied. MCG Clinical Criteria- Information on Highmark's incorporation of MCG Health evidence-based clinical guidelines into Highmarks criteria of clinical decision support. For prior authorization requests handled by BCBSIL: There are two ways to initiate your request. Please join us in reflecting back on the best moments from Auth the Cuff in 2020. 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. 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 AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. IMPORTANT: In the coming days, we will be migrating systems for our The system can easily be made an extension of the clients existing claims workflow. Please click here to register for an account. Report Fraud & Abuse | 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. %PDF-1.6 % What types of radiology procedures require prior authorization? Forgot Password? Registration, user access/ account assistance, portal navigation, error message understanding. <> By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. Copyright 2022 eviCore healthcare. Annual Utilization Statistics | Click herefor the MFA registration & setup guide. <> PDF 1-888-693-3210 http://www.medsolutions.com/implementation/abhil - Aetna wont be able to apply to eviCore openings. Register Now How does eviCore interact with providers? 1-800-972-8382. In keeping with DFS guidance, MetroPlusHealth's UM protocols resumed on June 22, 2020, including resuming issuing Prior Approvals and performing concurrent review. 410 N. 44th Street, Suite 900. Create an Account. Annual Utilization Statistics | For commercialprior authorization requests handled by AIM Specialty Health(AIM): Commercial non-HMO prior authorization requests can be submitted to AIM intwo ways. . Q4: How can eviCore make it easier for you to use this website? 2 0 obj Check status of submitted authorizations. External link You are leaving this website/app (site). 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). The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. Fax 866-873-8279. Annual Utilization Statistics | eviCore healthcare (eviCore) Obtain benefit preauthorization for certain care categories. 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. 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. Privacy Policy | Behavioral health. 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). reCAPTCHA is not valid; Please try again! Providers who do not have NaviNet,can use the HIPAA Health Services Review (278) electronic transactions for some types of authorizations. E-Verify and IER Right to Work. Authorizations/Precertifications | GEHA The terms of the members plan control the available benefits. eviCore intelliPath reflects eviCores commitment to modernize prior authorization and remove barriers to evidence-based care. If you have any questions, call the number on the member's ID card. You'll find more information on authorizations in the GEHA plan brochure. we will be implementing changes to evicore.com in the near future. Sometimes, a plan may require the member to request prior authorization for services. eviCore positions. E-Verify and IER Right to Work. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. Create an Account. [{"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. please email the case number and request to: reqcriteria@eviCore.com. 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. Fax all requests for services that require prior authorization to: Inpatient: 1-844-430-6806. 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 healthcare - Horizon NJ Health All Rights Reserved. Preauthorization Lists | EmblemHealth Frequently asked questions about requesting authorization from eviCore healthcare 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. 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. 0 Services billed with the following revenue codes always require prior authorization: 0240-0249 All-inclusive ancillary psychiatric. Forgot Password? we will be implementing changes to evicore.com in the near future. Part of it involves making sure the computer speaks the same language as the medical records. Thank you for submitting information. eviCore made it easy to complete my primary task online. Should I reschedule? You can also see eviCore healthcare's criteria and get request forms at . *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * As a valued user of our website, we'd appreciate your feedback to help us improve your website experience. Another part is having access to an exceptionally large volume of historical cases. 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. Trials, Treatments, and Oncology Breakthroughs, Check Status of Existing Prior Authorization. It indicates which codes are handled by a vendor. Subject: Sign- up for eviCore Healthcare's Training for new Prior Authorization requirements! Tune into our new Auth the Cuff episode with eviCore's Dianne Doherty, Sr. Q1: Overall, how satisfied are you with eviCores website? Thank you for using eviCores website today! reCAPTCHA is not valid; Please try again! Authorizations and PSODs | Provider | Priority Health Mailing address. For additional resources on the Helion Arc authorization process, includinginstructionalvideos,CLICK HERE. 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 . Learn about the growing field, along with eviCore and Alegis Care's home solutions on our new Auth the Cuff podcast episode with Dr. Yvette LeFebvre, Chief of PAC/DME/Sleep Services. For inpatient hospital stays, your doctor will get prior authorization from HAP. Genetic Testing | Prior Authorized Utilization Review | Lab - eviCore All Requests: Utilize Authorization Inquiry function in NaviNet. Information for Blue Cross and Blue Shield of Illinois (BCBSIL) members is found onour member site. Why is eviCore providing intelliPath ePA free of charge for eviCore-managed lives? Some requests are handled by BCBSIL; others are handled by utilization management vendors. Radiation Therapy: Call: 1 (866) 686-4452 . It speaks to the rapidly evolving healthcare industry, especially the increasing role of prior authorization and how providers can more effectively navigate it. If you do not hear back from us within 5 business days, please call, Please enter provider primary location address.

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