evicore prior authorization phone numberevicore prior authorization phone number

Call 1-888-233-8158 from 8:00 a.m. to 9:00 p.m., Eastern, Monday through Friday. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. GHI Medicare non-City of New York. I need to change the CPT code on my request. As a valued user of our website, we'd appreciate your feedback to help us improve your website experience. 1-888-MDAETNA (1-888-632-3862) (TTY: 711) for all other plans. Why was my test, treatment, or procedures not approved? Beginning Friday, December 18th at 5:00pm EST, you Moreover, eviCore is the only company in the industry with dedicated, separately maintained pediatric guidelines. Electronic Data Interchange (EDI) Email: EDI@premera.com To contact Customer Care, please call the phone number on the back of your Member ID Card. 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! They are discussing how recent technology innovations will be utilized to better partner with providers as we work to redefine healthcare and drive value to patients. Echocardiograms also just so happen to be one of the most common inappropriately ordered tests. Q1: Overall, how satisfied are you with eviCores website? jandbmedical.com. services by chiropractors. How does eviCore handle large gene panels? Thank you for using eviCores website today! Phone - Call eviCore toll-free at 855-252-1117 . In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. Fax the request form to 888.647.6152. How does eviCore interact with providers? eviCore.com. A prior authorization isnota guarantee of benefits or payment. we will be implementing changes to evicore.com in the near future. Prior Authorization | Blue Cross and Blue Shield of Illinois - BCBSIL Providers and/or staff can request prior authorization and make revisions to existing cases by calling 1-866-496-6200. 400 Buckwalter Place Blvd. 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. How does eviCore communicate with the patients provider? Medical knowledge is doubling faster than ever, as are advances on insights to access and treatment options for medical oncology. If you have any questions about this notice, please the Prior Authorization Department at (646) 473-7446. Were still hiring for other 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. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. endobj Report concerns to the BCBSIL Special Investigations Department (SID) Fraud website 1 . Member Rights Policy | See Clinical Corner for services that require Preauthorization. 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. Do you offer a mandatory prior authorization program for all sleep studies? 6 0 obj In practice, utilization management plays a large role in patient safety and empowerment. 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 Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. Note: Most out-of-network services require utilization management review. Dont I have to go to a hospital for my procedure? Forgot Password? What is included in the Medical Oncology program? Fax all requests for services that require prior authorization to: Inpatient: 1-844-430-6806. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status The authorization is typically obtained by the ordering provider. This podcast was created with the providers in mind. 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. If you do not hear back from us within 5 business days, please call, Please enter provider primary location address. 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. CHCP - Resources - RADIOLOGY IMAGING - Cigna Privacy Policy | hb```|7@($qFqr&kX Q8rC%xd]ZG{5LA[K;:]*${;fR4kE[zGV@EFH;!Az. Prior Authorization Automation. Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST. Please complete the Dental Specialty Referral Request Form and fax to 480-350-2217, email to: HCHdentaldeptHCA@azblue.com, or mail to: BCBSAZ Health Choice, Inc. Attn: Dental Prior Authorization. eviCore healthcare (eviCore) Obtain benefit preauthorization for certain care categories. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. Or you can call Provider Services at . What is included in the Cardiovascular solution? eviCore.com 1-855-252-1117. Use the link and toll-free phone number to access your training. ** Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. IMPORTANT: In the coming days, we will be migrating systems for our For government programs prior authorization requests handled by eviCore healthcare (eviCore): 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. PDF Requesting Authorization from eviCore healthcare - FAQ - BCBSM Thank you for using eviCores website today! BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. Directory Who to Contact for Preauthorization All providers must verify member eligibility and benefits prior to rendering non-emergency services. You'll find more information on authorizations in the GEHA plan brochure. The Role of Prior Authorization at eviCore | Evernorth 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). Or . Review claim status and request claim adjustments. For precertification, go online to eviCore.com or use the contact information below. Thank you for using eviCores website today! The site may also contain non-Medicare related information. For quick reference, see the GEHA member's ID card. Ethics & Compliance | eviCore intelliPath reflects eviCores commitment to modernize prior authorization and remove barriers to evidence-based care. How does my doctor access the Specialty Drug Management solution? 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. Usually, the provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider. Registration, user access/ account assistance, portal navigation, error message understanding. To check on the status of an authorization, please visit our provider secure web portal. 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 *, 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, wed appreciate your feedback to help us improve your website experience. Highmark has partnered witheviCorehealthcare (eviCore) for the following programs: Highmarkcontracts withWholeHealth Networks, Inc. (WHN), a subsidiary of Tivity Health Support, LLC.,forphysical medicine services- and naviHealth for Post-Acute Care for Medicare Advantage members. How do I know when my test has been authorized? This new site may be offered by a vendor or an independent third party. What are my options when a case is denied? eviCore made it easy to complete my primary task online. The diagnostic exams requiring prior authorization generally include the following procedures*: *prior authorization of certain procedures can vary by health plan. What services are managed through the Musculoskeletal Pain Management Program? Authorizations/Precertifications | GEHA 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. stream The eviCore intelliPath. . All Rights Reserved. Radiation Therapy: Call: 1 (866) 686-4452 . In addition, some sites may require you to agree to their terms of use and privacy policy. How did you get my phone number/information? Telephone:For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. Terms of Use | 0 Username Password Register for an account Retrieve Username Retrieve Password IMPORTANT: In the coming days, we will be migrating systems for our Sometimes, a plan may require the member to request prior authorization for services. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * 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. You will be contacted by an eviCore representative within 5 business days. All Rights Reserved. Use theAvailityProvider Portalor your preferred vendor to check eligibility and benefits before rendering services. Were still hiring for other reCAPTCHA is not valid; Please try again! E-Verify and IER Right to Work. Providers | Getting Started | Starting A New Prior Authorization - eviCore 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. If you are a Highmark network provider and have not signed up for NaviNet, learn how to do sohere. If you have any questions, call the number on the member's ID card. Fax 866-873-8279. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Prior Authorization Requirements - Amerigroup 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. Register Now In addition, some sites may require you to agree to their terms of use and privacy policy. Forgot Password? Q1: Overall, how satisfied are you with eviCores website? Annual Utilization Statistics | PROVIDERS AREA. eviCore made it easy to complete my primary task online. reCAPTCHA is not valid; Please try again! 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 . How will prior authorization determinations be communicated? *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Copyright 2022 eviCore healthcare. Were still hiring for other Report Fraud & Abuse | And its provided as a free service for eviCore-managed case volume. 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. What is included in the Radiology solution? Care Management Programs Contact Us - MVP Health Care 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). Highmark Western and Northeastern New York Inc., serves eight counties in Western New York under the trade name Highmark Blue Cross Blue Shield of Western New York and serves 13 counties in Northeastern New York under the trade name Highmark Blue Shield of Northeastern New York. :|gx7e#FB|+9?{RX7:!m$wCrrra4Ok2gfMrTsw Reminding and guiding patients to get the care they need. wont be able to apply to eviCore openings. Privacy Policy | PDF Prior authorization requirements - mercyoptions.net Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) prior to performing the procedure or service. There is a notion of utilization management being solely focused on cost savings. Member Rights Policy | Emergency services are an exception. The associated preauthorization forms can be found here. Provider Support | eviCore In addition, they face growing administrative burdens. PDF Visit www.evicore.com eviCore Pre-authorization Call 800.533.1206 What services are managed through the Musculoskeletal Therapies Program? Copyright 2022 eviCore healthcare. Please click here to register for an account. Continue to Authorization Lookup Login Log In Forgot User ID? IMPORTANT: In the coming days, we will be migrating systems for our Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. eviCore will communicate the determination utilizing the following methods: : 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. 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. 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. Thank you for submitting information. 571 0 obj <>stream 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. eviCore positions. All Rights Reserved. What types of services are managed under your sleep solution? The online portal is designed to facilitate the processing ofauthorizationrequests in a timely, efficient manner. External link You are leaving this website/app (site). ** Exception: Diabetic shoes and inserts are handled by Northwood, Inc . eviCore Prior Authorization Program | Blue Cross and Blue - BCBSTX open positions so continue your job search at Cigna.com/careers. Ethics & Compliance | 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 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. Prior Authorization - BCBSAZ Health Choice One option is Adobe Reader which has a built-in reader. Contact Us | Blue Cross and Blue Shield of Illinois - BCBSIL Clinical guidelines are becoming increasingly necessary to get proper testing, but not all guidelines are created equal. eviCoreis an independent company that provides specialty medical benefits management for BCBSTX. xUn@}?SeGbWZ"%@T%!RUE}\ZCRPC }X9sf8;;wngs!%`%9y+tVpz``j&[gc; L5uL"C|@8%*i0NeeFETPr$s@?(fXf,bj)z] p)c3+$Ht^NJ)('z#jc'C&9.BaE7K\ed:2\ueD(AqupHO([itZqIuX.UvV,VW7q|U}[dEMz@T`xbSg:qbL}yb Al55&9)T9^6'PZ'CGjtt Tk[&nX^\C`=?EAy5z-WWVx/)p=]l8N/q%KDs!wfk!P! Meet Dr. Scarborough, Chief of Radiology & SVP of Medical Affairs. If you do not remember your password, please click "Retrieve Password" below. Fax (24-hour) at 866-809-1370 . Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. endobj wont be able to apply to eviCore openings. hbbd```b`` {dd"Xdw&e7eu"j`RH2f@d\B;IH~ BCBSAZ-TPA co-administered plans (prefixes K8Y, K8Z, and NBT) . Providers who do not have NaviNet,can use the HIPAA Health Services Review (278) electronic transactions for some types of authorizations. 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. Terms of Use | You can also see eviCore healthcare's criteria and get request forms at . Create an Account. Prior Authorizations. Request Prior Authorization and Check Status Online via Provider Access Additional information on authorizations can be found in Chapter 5 (Care & Quality Management) of the Highmark Provider Manual. 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. All Rights Reserved. of authorization request(s). Beginning Friday, December 18th at 5:00pm EST, you Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Digital Breast Tomosynthesis is a Hot Topic, Global Shortage of Iodinated Contrast Media, Q&A: eviCores Chief of Radiology on the Need for Evidence-Based Imaging, The 8 Most Common Inappropriately Ordered Tests and Why They're Being Denied, Check Status of Existing Prior Authorization. Pharmacy Prior Authorization eviCore Medical Oncology Drug List Tune into our new Auth the Cuff podcast episode with guest Dr. David-Park, Sr. Medical Director PAC/DME, for a great conversation on over utilization, a real-life patient example, and more. PDF eviCore Outpatient Diagnostic Imaging Medical Necessity Program - CDPHP Why do we recommend conservative treatment options first? 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. endobj % How do I obtain clinical certification for cardiovascular tests? Eligibility Verification Providers should verify member eligibility prior to requesting/providing services. Prior authorization is required by Carelon Medical Benefits Management (formerly AIM . Why is eviCore providing intelliPath ePA free of charge for eviCore-managed lives? Our proprietary integrated system, Claims Studio, delivers savings through an enhanced focus on accurate claims payment. Portal:The preferred - and fastest - method to submit preauthorization requests and receive approvals isNaviNet. Contact Us | UHCprovider.com Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. Services requiring prior authorization through eviCore are outlined below. Q4: How can eviCore make it easier for you to use this website? 888-482-8057 Mon.-Fri., 8am - 11pm ET Sat., 8am - 3pm ET. <> Ethics & Compliance | Terms of Use | Learn more about the life-interrupting issue of back pain, and the long-term benefits of saving surgery for a last resort. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Privacy Policy | Examples of services that may require authorization include the following. How does eviCore interact with Post-Acute Care patients? How does a computer make healthcare decisions? If the requested exam is denied, eviCore will notify both you and your physician and provide you with detailed appeal instructions. Hospital and Outpatient Services. Member Rights Policy | Online forms from eviCore's carriers hub MENU PROVIDERS About; Solutions. IMPORTANT: In the coming days, we will be migrating systems for our reCAPTCHA is not valid; Please try again! Driving Directions Prior authorization fax: 800-267-8328 Behavioral health prior authorization fax: 877-840-5581. Provider Authorization - MetroPlusHealth Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. Effective 10/13/2017 - 12/31/2020. 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. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. In some instances repeat exams for condition treatment or management will require prior authorization. For many services, we manage the precertification process directly. CareCore National Web Portal Intake form. An eviCore representative will review the information submitted to determine the next level of review for this request. The "Live Sessions" page will display. 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. 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. My procedure is scheduled soon and I havent heard if my case is approved or not. All Rights Reserved. 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 . BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. Member Rights Policy | Contact Us - Availity Please click here to register for an account. Prior Authorization | Mercy Care Prior Authorization and Notification | UHCprovider.com E-Verify and IER Right to Work. Fraud Hotline. CareCore National, LLC d/b/a eviCore healthcare (eviCore) . Report Fraud & Abuse | The site may also contain non-Medicare related information. You may also go directly to eviCore's self-service web portal at www.evicore.com. Services billed with the following revenue codes always require prior authorization: 0240-0249 All-inclusive ancillary psychiatric. Contact Us; Search. 1-800-624-0756 (TTY: 711) for HMO and Medicare Advantage benefits plans. eviCore positions. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Preauthorization Lists New Empire Precertification Requ .