As a valued user of our website, wed appreciate your feedback to help us improve your website experience. [{"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 is required by eviCore healthcare for services performed for adult 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). The system can easily be made an extension of the clients existing claims workflow. In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. Privacy Policy | All Rights Reserved. Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. What is included in eviCores Comprehensive Oncology program? eviCore positions. :|gx7e#FB|+9?{RX7:!m$wCrrra4Ok2gfMrTsw Refer to the Procedures that require authorization by eviCore healthcaredocument for more details. Moving forward, please visit CoverMyMeds or via SureScripts in your EHR to learn more and submit all new PA requests electronically. 539 0 obj <> endobj If the provider or member doesnt get prior authorization for out-of-network services, the claim may be denied. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. Q4: How can eviCore make it easier for you to use this website? Portal:The preferred - and fastest - method to submit preauthorization requests and receive approvals isNaviNet. 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. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Privacy Policy | Lab Prior Authorization CPT Code List. endobj You will be contacted by an eviCore representative within 5 business days. What is included in the Medical Oncology program? Please click here to register for an account. Why would I switch to intelliPath ePA? Contact Us - Health Care Providers - Aetna eviCore positions. Please click here to register for an account. open positions so continue your job search at Cigna.com/careers, Were on a quest to improve the experience of administrators, clinicians, and patients who work with us. 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. E-Verify and IER Right to Work. Were still hiring for other 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. The field of gastroenterology is evolving. The authorization is typically obtained by the ordering provider. Note: Most out-of-network services require utilization management review. What services are managed through the Musculoskeletal Pain Management Program? To check on the status of an authorization, please visit our provider secure web portal. Thank you for using eviCores website today! If you have any questions, call the number on the member's ID card. I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? How does a provider check the prior authorization status for a member? What can physical therapy do for my lower back pain? If you need preauthorization, contact eviCore in one of three ways: Get immediate approval by submitting your request at www.evicore.com. Prior Authorization | 1199SEIU Funds 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. One option is Adobe Reader which has a built-in reader. Report Fraud & Abuse | Federal Employee Program (FEP ) Verify eligibility and benefits and/or check claim status for FEP members. CHCP - Resources - Precertification - Cigna Prior authorization fax: 800-267-8328 Behavioral health prior authorization fax: 877-840-5581. Privacy Policy | Or you can call Provider Services at . 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. 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. Ethics & Compliance | reCAPTCHA is not valid; Please try again! 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. Were still hiring for other With more than 25 years experience in utilization management, eviCore understands that maintaining a truly supportive provider experience requires more than supplying a few training sessions and establishing a phone line for questions. The procedure codes contained in the lists below usually require authorization (based on the members benefit plan/eligibility). Certain employer groups may require prior authorization or pre-notification through other vendors. Report Fraud & Abuse | E-Verify and IER Right to Work. PDF Prior Authorization Requests - Quick Guide - AZBlue Were still hiring for other Thank you for using eviCores website today! Please click here to register for an account. endobj endstream Annual Utilization Statistics | Fax 866-873-8279. Terms of Use | of authorization request(s). MCG Clinical Criteria- Information on Highmark's incorporation of MCG Health evidence-based clinical guidelines into Highmarks criteria of clinical decision support. x]$9n7P&zK_0wv/"}Rla@hT_RIQD*;R{|Gvg|\~I%_)u. This new site may be offered by a vendor or an independent third party. ** Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. The Role of Prior Authorization at eviCore | Evernorth List. ** Exception: Diabetic shoes and inserts are handled by Northwood, Inc . (This information should not be relied on as authorization for health care services and is not a guarantee of payment.). Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 3 0 obj 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. You might find that the answer is simpler than you think! Step 2If prior authorization is required, have the following information ready: Step 3 Submit Your Prior Authorization Request. 4 0 obj Listen to our latest podcast episode with new host, Dr. Emily Coe featuring Dr. Mayank Shah. Tune into our new Auth the Cuff episode with eviCore's Dianne Doherty, Sr. % eviCore intelliPath . Reminding and guiding patients to get the care they need. Ethics & Compliance | Why is eviCore providing intelliPath ePA free of charge for eviCore-managed lives? The terms of the members plan control the available benefits. Online Forms | Providers Hub | eviCore - Prior Authorizations This is not an all-inclusive list. "eviCore has over 1,100 doctors, therapists and nurses from a variety of specialties. : Chiropractic Low Back Pain, Gastroenterology Is Turning Science Fiction Into Reality, Healthcare Its Simpler Than We All Think, Just Because You Can, Doesnt Mean You Should, New Perspective, Same Focus: Utilization Management & Patient Safety, Redefining Home Healthcare and Reducing (Re)Admissions, Specialized Therapy Services: Reducing Pain and Beyond. Why do we recommend conservative treatment options first? jandbmedical.com. E-Verify and IER Right to Work. 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. Simply visit the eviCores Providers Hub page and select the health plan and solution option for your case in the training section. Use the link and toll-free phone number to access your training. Learn more from eviCore experts Sid Govindan, MD and John Young on how eviCore is applying these technologies to evolve the prior authorization process. This podcast was created with the providers in mind. EmblemHealth Reduces Preauthoriz . eviCore Healthcare | Empowering the Improvement of Care Member Rights Policy | Fax all requests for services that require prior authorization to: Inpatient: 1-844-430-6806. Prior authorization is required by Carelon Medical Benefits Management (formerly AIM . Create an Account. Second, when requests reach a final status, the patient receives a letter indicating whether the request has been approved or denied. Hospitals should contact CareAllies at (800) 227-9360 to obtain prior authorization. Privacy Policy | In practice, utilization management plays a large role in patient safety and empowerment. 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? 4. wont be able to apply to eviCore openings. 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. Online - The eviCore Web Portal is available 24x7. Meet Dr. Scarborough, Chief of Radiology & SVP of Medical Affairs. 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. <>>> 6 0 obj MEDICAL POLICIES Providers who do not have NaviNet,can use the HIPAA Health Services Review (278) electronic transactions for some types of authorizations. 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. Report Fraud & Abuse | Thank you for using eviCores website today! Prior Authorization | Blue Cross and Blue Shield of Illinois - BCBSIL Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Why didn't you call me the last time I had a procedure? reCAPTCHA is not valid; Please try again! All Rights Reserved. The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. 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. 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. Please click here to register for an account. Request Prior Authorization and Check Status Online via Provider Access Use theAvailityProvider Portalor your preferred vendor to check eligibility and benefits before rendering services. Benefits can vary; always confirm member coverage. Please utilize our live chat feature which is available 7AM-7PM EST M-F. Privacy Policy | <> *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Subject: Sign- up for eviCore Healthcare's Training for new Prior Authorization requirements! What is the fastest way to do this? CHCP - Resources - Sleep management - Cigna CHCP - Resources - RADIOLOGY IMAGING - Cigna BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. You can also see eviCore healthcare's criteria and get request forms at . You can request an expedited appeal by calling the prior authorization number for the plan that covers your patient. How does a computer make healthcare decisions? Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. we will be implementing changes to evicore.com in the near future. Continue to Authorization Lookup Login Log In Forgot User ID? If you have questions on a request handled by AIM or eviCore, call the appropriate vendor, as noted above. Who to Contact for Preauthorization | EmblemHealth Please click here to register for an account. What types of services are managed under your sleep solution? *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Call Center: eviCore's is available from 7 a.m. to 7 p.m. How does eviCore handle large gene panels? wont be able to apply to eviCore openings. Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST. Participating providers can find more precertification phone numbers in Participating provider precertification list for Aetna (PDF). We also provide helpful resources on how to navigate the prior authorization process, including provider playbooks and tips on how to maximize the process short of a peer-to-peer phone call. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. eviCores innovative SmartChoice program serves as a patient-outreach service that educateshealth plan members on available options for their advanced imaging procedure locations. Inpatient Planned Requests: Call Highmark Clinical Services; Press 2 for authorization requirements/ status. 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. 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. For government programs prior authorization requests handled by eviCore healthcare (eviCore): we will be implementing changes to evicore.com in the near future. Another part is having access to an exceptionally large volume of historical cases. Were on a quest to improve the experience of administrators, clinicians, and patients who work with us. hb```|7@($qFqr&kX Q8rC%xd]ZG{5LA[K;:]*${;fR4kE[zGV@EFH;!Az. we will be implementing changes to evicore.com in the near future. In addition, some sites may require you to agree to their terms of use and privacy policy. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. This step will also help you determine if your services require prior authorization throughBCBSTXoreviCore. we will be implementing changes to evicore.com in the near future. Well before the pandemic, consumers were leaning towards home healthcare versus facility based care when appropriate for a number of reasons. Benefit plans vary widely and are subject to change based on the contract effective dates. How do I obtain clinical certification for radiology tests? Thank you for using eviCores website today! Driving Directions Provider Resource Center In addition, they face growing administrative burdens. Contact us Chat with us now. Call Customer Service at 888-850-8526, 8 a.m. to 8 p.m., Monday through Sunday. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. View fee schedules, policies, and guidelines. I need to change the date on my request. Our network of quality providers offers an attractive option for health plansseeking to more appropriately manage radiology benefits. 0901, 0905-0907, 0913, 0917 Behavioral health treatment services. Report Fraud & Abuse | Review claim status and request claim adjustments. Call 1-800-TALK-MVP (1-800-825-5687) to speak with an MVP representative. If you are a Highmark network provider and have not signed up for NaviNet, learn how to do sohere. PDF 1-888-693-3210 http://www.medsolutions.com/implementation/abhil - Aetna Tune into our new podcast episode with eviCore's medical oncologists Dr. McLead, Associate Medical Director, and Dr. Gaskins, Sr. Medical Director, for an informative conversation on clinical trials, disparities in medical oncology, and how eviCore is aiming to bridge the gap with the most recent evidence-based options for oncology patients. Service preapproval is based on the members benefit plan/eligibility at the time the service is reviewed/approved. External link You are leaving this website/app (site). The online portal is designed to facilitate the processing ofauthorizationrequests in a timely, efficient manner. Specialized therapies such as chiropractic, acupuncture, and physical therapy are cost effective, and can provide improved outcomes for chronic pain patients. How does eviCore interact with radiology patients? eviCore positions. Sessions offered May and June. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 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. PNS contact tool. Availity provides administrative services to BCBSIL. Were still hiring for other Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. 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, Contact Us | Office Locations | eviCore From cultural moments, to utilization management, capsule endoscopy technology advancements, and more. 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. Outpatient: 1-844-442-8012. . Report Fraud & Abuse | We start off todays podcast talking about echocardiograms, one of the coolest tests ever. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. E-Verify and IER Right to Work. endobj Copyright 2022 eviCore healthcare. Pre-authorization - Regence Should I reschedule? 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 site may also contain non-Medicare related information. And its provided as a free service for eviCore-managed case volume. You can verify benefits and request prior authorization at Availity.com or by phone at 1-888-693-3211 1-888-693-3211. 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. GHI Medicare non-City of New York. Authorizations and PSODs | Provider | Priority Health Frequently asked questions about requesting authorization from eviCore healthcare This information is intended to serve as a reference summary that outlines where information about Highmarks authorization requirements can be found. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. . What is included in the Cardiovascular solution? 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. 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, The diagnostic exams requiring prior authorization generally include the following procedures*: *prior authorization of certain procedures can vary by health plan. To view this file, you may need to install a PDF reader program. open positions so continue your job search at Cigna.com/careers. 1-800-972-8382. information about accessing the eviCore portal. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. open positions so continue your job search at Cigna.com/careers, Something went wrong.Please try again after some time, Thank you for submitting. Call Utilization Management at 855-339-8127, 9 a.m to 9 pm., Monday through Friday. All Rights Reserved. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. Authorizations/Precertifications | GEHA 2 0 obj of authorization request(s). Preauthorization Lists New Empire Precertification Requ . 1-800-624-0756 (TTY: 711) for HMO and Medicare Advantage benefits plans. IMPORTANT: In the coming days, we will be migrating systems for our Provider Authorization - MetroPlusHealth One option is Adobe Reader which has a built-in reader. 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, Please click here to register for an account. open positions so continue your job search at Cigna.com/careers. The reality is, most providers weren't initially trained to deliver virtual care. Hospital and Outpatient Services. Forgot Password? wont be able to apply to eviCore openings. %%EOF Intake form. eviCore intelliPath reflects eviCores commitment to modernize prior authorization and remove barriers to evidence-based care. Clinical Resourcespage on theBCBSTX Medicaidwebsite. Beginning Friday, December 18th at 5:00pm EST, you . For more specific contact information, choose the statement below that best represents you. 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).

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