Radiology Solution | Utilization Management | eviCore Introducing eviCores new podcast Auth the Cuff! Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. Thank you for using eviCores website today! open positions so continue your job search at Cigna.com/careers. Availity provides administrative services to BCBSIL. Continue to Authorization Lookup Login Log In Forgot User ID? . What is included in eviCores Comprehensive Oncology program? The "Live Sessions" page will display. All Rights Reserved. What do I do if a members eligibility is incorrect or not on file? Hospitals should contact CareAllies at (800) 227-9360 to obtain prior authorization. 1 0 obj Health Care Providers | BCBS of Tennessee Driving Directions How do I obtain clinical certification for cardiovascular tests? Copyright 2022 eviCore healthcare. In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. eviCore currently maintains a nationwide advanced imaging network, featuring contracts with providers of imaging services in specific/predetermined locationsand as well as freestanding facilities. Sign in Learn more about electronic authorization Pre-authorization lists Commercial This new site may be offered by a vendor or an independent third party. We start off todays podcast talking about echocardiograms, one of the coolest tests ever. Examples of services that may require authorization include the following. Copyright 2022Health Care Service Corporation. Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. How do I obtain clinical certification for radiology tests? Contact Us - Health Care Providers - Aetna (This information should not be relied on as authorization for health care services and is not a guarantee of payment.). What is included in the Radiology solution? As a valued user of our website, we'd appreciate your feedback to help us improve your website experience. Create an Account. Benefits > CHS Group Information" or call the prior authorization phone number on back of the member's ID card. Care Management Programs Pharmacy Prior Authorization eviCore Medical Oncology Drug List In some instances repeat exams for condition treatment or management will require prior authorization. IMPORTANT: In the coming days, we will be migrating systems for our If you have questions on a request handled by BCBSIL, contact our Medical Management department. 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. I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? x]$9n7P&zK_0wv/"}Rla@hT_RIQD*;R{|Gvg|\~I%_)u. List. E-Verify and IER Right to Work. 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). Preauthorization | Blue Cross & Blue Shield of Rhode Island eviCore positions. Portal:The preferred - and fastest - method to submit preauthorization requests and receive approvals isNaviNet. Call 1-800-TALK-MVP (1-800-825-5687) to speak with an MVP representative. For commercialprior authorization requests handled by AIM Specialty Health(AIM): Commercial non-HMO prior authorization requests can be submitted to AIM intwo ways. 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). Prior authorization is required by eviCore healthcare for services performed for adult Contact Us | Blue Cross and Blue Shield of Illinois - BCBSIL For more detailed information, including specific CPT codes that requireeviCoreprior authorization, visit theeviCore implementation siteand select the BCBSTX health plan for the applicable CPT/HCPCS code lists and physician worksheets by service. eviCore made it easy to complete my primary task online. In addition, some sites may require you to agree to their terms of use and privacy policy. Q4: How can eviCore make it easier for you to use this website? Beginning Friday, December 18th at 5:00pm EST, you You might find that the answer is simpler than you think! All Rights Reserved. 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. Contact Us | UHCprovider.com Some procedures may also receive instant approval. Terms of Use | *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Preauthorization Lists | EmblemHealth 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). If you have any questions, call the number on the member's ID card. The authorization is typically obtained by the ordering provider. reCAPTCHA is not valid; Please try again! Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. How does a computer make healthcare decisions? E-Verify and IER Right to Work. What services are managed through the Musculoskeletal Pain Management Program? 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. ", Chief of Radiology & SVP of Medical Affairs. [{"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. Most PDF readers are a free download. In addition, some sites may require you to agree to their terms of use and privacy policy. For inpatient hospital stays, your doctor will get prior authorization from HAP. Contact J&B at 1-888-896-6233 or . If you have questions, call eviCore healthcare at . E-Verify and IER Right to Work. 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. To request any additional assistance in accessing the guidelines, . The table will help you determine if you can use the approved prior authorization, modify the original or request a new one. And its provided as a free service for eviCore-managed case volume. Please use the BCBSAZ MA prior authorization fax form or the eviCore online request tool, available on the secure MA . Q4: How can eviCore make it easier for you to use this website? Continue to Authorization Lookup Login Log In Forgot User ID? 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. Frequently asked questions about requesting authorization from eviCore healthcare Prior authorization status can be viewed on demand via the eviCore portal at www.evicore.com or by calling eviCore at 866-220-3071. Watch this weeks episode of Auth the Cuff to learn more! Provider Support | eviCore To viewrequirements summaries andprocedure code lists, refer to theSupport Materials (Commercial)andSupport Materials (Government Programs)pages. 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. Prior Authorizations. Meet Dr. Scarborough, Chief of Radiology & SVP of Medical Affairs. What digital resources can I access to find out more information? Call 1 (800) 88CIGNA (882-4462). Do you ever ask the question about why you might need that MRI or CT scan? What additional tools are available as add-on programs to the Radiology solution? Prior Authorizations & Precertifications | Cigna You can verify benefits and request prior authorization at Availity.com or by phone at 1-888-693-3211 1-888-693-3211. Highmark recently launched the Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. In addition, they face growing administrative burdens. Prior Authorization Automation. Call Customer Service at 888-850-8526, 8 a.m. to 8 p.m., Monday through Sunday. Tune into our new Auth the Cuff episode with eviCore's Dianne Doherty, Sr. Check status of submitted authorizations. The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. Prior authorization fax: 800-267-8328 Behavioral health prior authorization fax: 877-840-5581. Contact Support | eviCore Support <>>>/BBox[ 0 0 576 201.59] /Matrix[ 0.125 0 0 0.35716 0 0] /Filter/FlateDecode/Length 7100>> By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. Note: Checking eligibility and benefits is key, butwe also have other resources to help you prepare. 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. Learn more about the life-interrupting issue of back pain, and the long-term benefits of saving surgery for a last resort. Refer to the Procedures that require authorization by eviCore healthcaredocument for more details. You may also go directly to eviCore's self-service web portal at www.evicore.com. To contact Customer Care, please call the phone number on the back of your Member ID Card. Authorizations and PSODs | Provider | Priority Health For prior authorization requests handled by BCBSIL: There are two ways to initiate your request. I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Q1: Overall, how satisfied are you with eviCores website? IMPORTANT: In the coming days, we will be migrating systems for our Prior Authorization | Blue Cross and Blue Shield of Illinois - BCBSIL EmblemHealth Preauthorization List. PROVIDERS AREA. Effective 10/13/2017 - 12/31/2020. What is included in the Cardiovascular solution? PDF Prior Authorization Requests - Quick Guide - AZBlue Contact Us - Availity 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! 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. wont be able to apply to eviCore openings. \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). The terms of the members plan control the available benefits. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. Q1: Overall, how satisfied are you with eviCores website? eviCore healthcare (eviCore) Obtain benefit preauthorization for certain care categories. 1-800-972-8382. Telehealth, Telemedicine Hologram Care? Annual Utilization Statistics | please email the case number and request to: reqcriteria@eviCore.com. My procedure is scheduled soon and I havent heard if my case is approved or not. If you donotget prior approval via the prior authorization process for services and drugs on our prior authorization lists: When and how should prior authorization requests be submitted? Certain employer groups may require prior authorization or pre-notification through other vendors. Eligibility and benefits can be verified by accessing NaviNet or by calling the number on the back of the members identification card. Report Fraud & Abuse | The site may also contain non-Medicare related information. For Prior Authorization requests, use one of the following: CoverMyMeds: Website: CoverMyMeds.com (Preferred) Call: 1 (877) 813-5595 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 Do you offer a mandatory prior authorization program for all sleep studies? Radiation Therapy: Call: 1 (866) 686-4452 . Helpful Resources: Authorization Grids 571 0 obj <>stream By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. 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, 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. Ethics & Compliance | Authorizations/Precertifications | GEHA The Member Customer Care Center is open Monday-Friday, 8 am to 6 pm (ET). For quick reference, see the GEHA member's ID card. Privacy Policy | Member Rights Policy | What types of radiology procedures require prior authorization? Learn more from eviCore experts Sid Govindan, MD and John Young on how eviCore is applying these technologies to evolve the prior authorization process. In addition, peer-reviewed literature, major treatises, input from health plans, and practicing academic and community-based physicians are also utilized in the construction of our guidelines. I need to change the date on my request. reCAPTCHA is not valid; Please try again! 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). Health Plans. The diagnostic exams requiring prior authorization generally include the following procedures*: *prior authorization of certain procedures can vary by health plan. 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 site may also contain non-Medicare related information. You can fax your authorization request to 1-800-217-9345. Were still hiring for other Forgot Password? eviCore interacts with radiology patients in two ways. In general, there arethreestepsprovidersshould follow. All Rights Reserved. You can also see eviCore healthcare's criteria and get request forms at . Outpatient: 1-844-442-8012. What is included in the Radiation Oncology program? While very useful when used appropriately, these studies have established some new guidelines to follow around this important test. MEDICAL POLICIES we will be implementing changes to evicore.com in the near future. 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. eviCores innovative SmartChoice program serves as a patient-outreach service that educateshealth plan members on available options for their advanced imaging procedure locations. Contact us Chat with us now. Beginning Friday, December 18th at 5:00pm EST, you Online Forms | Providers Hub | eviCore - Prior Authorizations Telephone:For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. 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, <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> PDF File is in portable document format (PDF). Ethics & Compliance | Prior Authorization Requirements - Amerigroup 888-482-8057 Mon.-Fri., 8am - 11pm ET Sat., 8am - 3pm ET. The provider is responsible for verification of member eligibility and covered benefits. 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. I got a message from a SmartChoice representative asking me to call back; why are you calling me? hb```|7@($qFqr&kX Q8rC%xd]ZG{5LA[K;:]*${;fR4kE[zGV@EFH;!Az. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. endobj Check eligibility and benefits for members. You are leaving this website/app (site). eviCore.com. Listen to our latest podcast episode with new host, Dr. Emily Coe featuring Dr. Mayank Shah. Please check directly with your health plan for specific requirements or contact eviCores Customer Service at (800) 918-8924. Manage practice information, access staff training and complete attestation requirements. 0901, 0905-0907, 0913, 0917 Behavioral health treatment services. Simply, notify HAP within 48 hours of the emergency admission. Annual Utilization Statistics | 1-888-MDAETNA (1-888-632-3862) (TTY: 711) for all other plans. Emergency room visits don't require prior authorization. Check Status of Existing Prior Authorization. Our hosts Dr. Torelli and Liz Avila are here to explain why. Q4: How can eviCore make it easier for you to use this website? A prior authorization isnota guarantee of benefits or payment. 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. 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. How will prior authorization determinations be communicated? Moreover, eviCore is the only company in the industry with dedicated, separately maintained pediatric guidelines. 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. Federal Employee Program (FEP ) Verify eligibility and benefits and/or check claim status for FEP members. One option is Adobe Reader which has a built-in reader. of authorization request(s). How does eviCore handle large gene panels? 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. E-Verify and IER Right to Work. Providers | Getting Started | Starting A New Prior Authorization - eviCore Call Center: eviCore's is available from 7 a.m. to 7 p.m. 2 0 obj Bonus! Q1: Overall, how satisfied are you with eviCores website? 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. we will be implementing changes to evicore.com in the near future. Forgot Password? MCG Clinical Criteria- Information on Highmark's incorporation of MCG Health evidence-based clinical guidelines into Highmarks criteria of clinical decision support. services by chiropractors. endobj Report concerns to the BCBSIL Special Investigations Department (SID) Fraud website 1 . Please click here to register for an account. If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. : 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. Once a prior authorization request is received and processed, the decision is communicated to the provider. stream Manage practice information, access staff training and complete attestation requirements. What is included in the Specialty Drug solution? eviCore made it easy to complete my primary task online. Receive support for technical or web portal related issue. 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. open positions so continue your job search at Cigna.com/careers, Something went wrong.Please try again after some time, Thank you for submitting. Step 2If prior authorization is required, have the following information ready: Step 3 Submit Your Prior Authorization Request. PDF Subject: Sign- up for eviCore Healthcare's Training for new Prior All Rights Reserved. How do I know when my test has been authorized? Review claim status and request claim adjustments. * 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. Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. Bluffton, SC 29910 Why would I switch to intelliPath ePA? 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. PDF Prior authorization requirements - mercyoptions.net If you have any questions about this notice, please the Prior Authorization Department at (646) 473-7446. . The reality is, most providers weren't initially trained to deliver virtual care. Multi-Factor Authentication (MFA) is now live on eviCores web portal! Q4: How can eviCore make it easier for you to use this website? All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. Prior authorization of a service is not a guarantee of payment of benefits. Contact Us; Search. If you need preauthorization, contact eviCore in one of three ways: Get immediate approval by submitting your request at www.evicore.com. Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST. In addition to verifying membership/coverage status and other important details,this step returns information on prior authorization requirements and utilization management vendors, if applicable. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. Providers can call toll-free at 1-855-252-1117 between 6 a.m. to 6 p.m. (central time) Monday through Friday and 9 a.m. - noon Saturday, Sunday and legal holidays. %PDF-1.6 % Q1: Overall, how satisfied are you with eviCores website? What types of cardiovascular procedures require prior authorization? Most PDF readers are a free download. IMPORTANT: In the coming days, we will be migrating systems for our Were on a quest to improve the experience of administrators, clinicians, and patients who work with us. 3 0 obj Our host Emily Coe, PhD, speaks with Alegis Care social worker Katie Sherman, MSW, LCSW, to learn more about home health, social determinants of health, access to care, and more. %PDF-1.5 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. Q4: How can eviCore make it easier for you to use this website? There is a notion of utilization management being solely focused on cost savings. 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. So how do we continue to think about best practices for telehealth? Find Contact Information; Podcasts; GO TO PROVIDER'S HUB. 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. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * You'll find more information on authorizations in the GEHA plan brochure. Request Prior Authorization and Check Status Online via Provider Access Please click here to register for an account. The incredibly popular & eloquent nuclear stress test has been the subject of some recent studies on frequency. eviCore positions. Login | Providers | Excellus BlueCross BlueShield
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