Online Forms | Providers Hub | eviCore - Prior Authorizations You are leaving this website/app (site). Do you offer a mandatory prior authorization program for all sleep studies? For prior authorization requests handled by BCBSIL: There are two ways to initiate your request. Were still hiring for other MCG Clinical Criteria- Information on Highmark's incorporation of MCG Health evidence-based clinical guidelines into Highmarks criteria of clinical decision support. This podcast was created with the providers in mind. Benefits can vary; always confirm member coverage. Always check eligibility and benefits first,via theAvailityEssentialsor your preferred web vendor, prior to rendering care and services. You may also go directly to eviCore's self-service web portal at www.evicore.com. Federal Employee Program (FEP ) Verify eligibility and benefits and/or check claim status for FEP members. External link You are leaving this website/app (site). Preauthorization Lists | EmblemHealth of authorization request(s). Member Rights Policy | 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? What are my options when a case is denied? Q4: How can eviCore make it easier for you to use this website? What claims are subject to claims review? eviCore intelliPath . PDF Requesting Authorization from eviCore healthcare - FAQ - BCBSM Contact Support | eviCore Support Check eligibility and benefits for members. Tune into our new Auth the Cuff episode with eviCore's Dianne Doherty, Sr. How do I know when my test has been authorized? 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. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization. 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. Were still hiring for other Based on the feedback we receive, we continuously upgrade our operational efficiencies through ongoing addition of Web enhancements that improve the user experience and offeradditional support to our providers. 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. services by chiropractors. We would like to help. In some instances repeat exams for condition treatment or management will require prior authorization. 0901, 0905-0907, 0913, 0917 Behavioral health treatment services. Member Rights Policy | My procedure is scheduled soon and I havent heard if my case is approved or not. endobj Information for Blue Cross and Blue Shield of Illinois (BCBSIL) members is found onour member site. Provider Contacts | Provider | Premera Blue Cross Q4: How can eviCore make it easier for you to use this website? 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! The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. We start off todays podcast talking about echocardiograms, one of the coolest tests ever. Q4: How can eviCore make it easier for you to use this website? A prior authorization isnota guarantee of benefits or payment. What is the fastest way to do this? E-Verify and IER Right to Work. Member Rights Policy | 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. While very useful when used appropriately, these studies have established some new guidelines to follow around this important test. Tune into our latest Auth the Cuff podcast episode featuring pediatric oncologists Dr. Michelle Neier and Dr. Jessica Roberson, along with pediatric radiologist Dr. Keith Kronemer, who speak with Dr. Emily Coe on the impact COVID-19 has had, and may continue to have, on pediatric care. . Apr 06, 2023. All Rights Reserved. Thank you for using eviCores website today! Learn more from eviCore experts Sid Govindan, MD and John Young on how eviCore is applying these technologies to evolve the prior authorization process. The diagnostic exams requiring prior authorization generally include the following procedures*: *prior authorization of certain procedures can vary by health plan. Some procedures may also receive instant approval. Ethics & Compliance | Medical knowledge is doubling faster than ever, as are advances on insights to access and treatment options for medical oncology. Please use the BCBSAZ MA prior authorization fax form or the eviCore online request tool, available on the secure MA . Forgot Password? What if the request does not meet clinical criteria? For additional resources on the Helion Arc authorization process, includinginstructionalvideos,CLICK HERE. To request any additional assistance in accessing the guidelines, . eviCore made it easy to complete my primary task online. The site may also contain non-Medicare related information. Ethics & Compliance | Care Management Programs Inpatient Planned Requests: Call Highmark Clinical Services; Press 2 for authorization requirements/ status. wont be able to apply to eviCore openings. 3 0 obj open positions so continue your job search at Cigna.com/careers. Online - The eviCore Web Portal is available 24x7. All Rights Reserved. Or you can call Provider Services at . Driving Directions It speaks to the rapidly evolving healthcare industry, especially the increasing role of prior authorization and how providers can more effectively navigate it. Additional information about the programs and links to prior authorization codes are available under Care Management Programs in the left website menu. Report Fraud & Abuse | Meet Dr. Scarborough, Chief of Radiology & SVP of Medical Affairs. Please click here to register for an account. 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. Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? Refer to the March 30, 2023, provider notice (PDF) for more information and to register for training based on your physicians specialty. How did you get my phone number/information? Thank you for using eviCores website today! Refer to theeviCore Webexpage to register and the select the menu bar symbol located on the left-side of the webpage and select "Webex Training". Availity provides administrative services to BCBSIL. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * 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. Why is eviCore providing intelliPath ePA free of charge for eviCore-managed lives? BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. 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: 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. By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. 1-888-693-3211 (TTY: 711). PDF File is in portable document format (PDF). Were still hiring for other 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. 1-800-624-0756 (TTY: 711) for HMO and Medicare Advantage benefits plans. All web users may now protect their portal accounts with an additional layer of security, including e-mail & SMS. Most PDF readers are a free download. The "Live Sessions" page will display. 4. 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. The site may also contain non-Medicare related information. What additional tools are available as add-on programs to the Radiology solution? One option is Adobe Reader which has a built-in reader. Obtain prior authorizations through eviCore using one of the following methods: eviCoreperiodically will host orientation sessions for providers for various care categories. Thank you for submitting information. You will be contacted by an eviCore representative within 5 business days. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Beginning Friday, December 18th at 5:00pm EST, you Preauthorization Lists New Empire Precertification Requ . Report Fraud & Abuse | PROVIDERS AREA. To viewrequirements summaries andprocedure code lists, refer to theSupport Materials (Commercial)andSupport Materials (Government Programs)pages. Provider costs are reduced and decisions are communicated in real time, reducing delays. Ethics & Compliance | Call 1 (800) 88CIGNA (882-4462). 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. Contact us | Providers | Independence Blue Cross (IBX) If you do not remember your password, please click "Retrieve Password" below. ** Exception: Diabetic shoes and inserts are handled by Northwood, Inc . If the requested exam is denied, eviCore will notify both you and your physician and provide you with detailed appeal instructions. reCAPTCHA is not valid; Please try again! Please click here to register for an account. 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. 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. External link You are leaving this website/app (site). Contact Us; Search. eviCore positions. Were on a quest to improve the experience of administrators, clinicians, and patients who work with us. Call Center: eviCore's is available from 7 a.m. to 7 p.m. The site may also contain non-Medicare related information. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Please click here to register for an account. Fax 866-873-8279. 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, 2 0 obj Beginning Friday, December 18th at 5:00pm EST, you EmblemHealth Preauthorization List. Portal Login Insights Blog eviCore Colorectal Screening Program All Rights Reserved. Authorizations for HDHP, Standard and High Option members As a valued user of our website, we'd appreciate your feedback to help us improve your website experience. What do I do if a members eligibility is incorrect or not on file? 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. . I need to change the date on my request. All Rights Reserved. Reminding and guiding patients to get the care they need. Please click here to register for an account. 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. What types of cardiovascular procedures require prior authorization? Contact Us - Health Care Providers - Aetna %PDF-1.6 % 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. Radiation Therapy: Call: 1 (866) 686-4452 . Watch this weeks episode of Auth the Cuff to learn more! Providers and/or staff can request prior authorization and make revisions to existing cases by calling 1-866-496-6200. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. Terms of Use | In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. For quick reference, see the GEHA member's ID card. Thank you for using eviCores website today! Utilization Management. reCAPTCHA is not valid; Please try again! In practice, utilization management plays a large role in patient safety and empowerment. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Continue to Authorization Lookup Login Log In Forgot User ID? From cultural moments, to utilization management, capsule endoscopy technology advancements, and more. Medical Oncology: Call: 1 (866) 668-9250 Fax: 1 (800) 540-2406. In addition, some sites may require you to agree to their terms of use and privacy policy. eviCore made it easy to complete my primary task online. 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. If you are a Highmark network provider and have not signed up for NaviNet, learn how to do sohere. In general, there arethreestepsprovidersshould follow. Sign in Learn more about electronic authorization Pre-authorization lists Commercial Eligibility and benefits can be verified by accessing NaviNet or by calling the number on the back of the members identification card. reCAPTCHA is not valid; Please try again! List. It indicates which codes are handled by a vendor. 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). Member Rights Policy | Copyright 2022 eviCore healthcare. Thank you for using eviCores website today! Annual Utilization Statistics | Simply visit the eviCores Providers Hub page and select the health plan and solution option for your case in the training section. What types of radiology procedures require prior authorization? 888-482-8057 Mon.-Fri., 8am - 11pm ET Sat., 8am - 3pm ET. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status You can fax your authorization request to 1-800-217-9345. Privacy Policy | Where are Musculoskeletal Program guidelines and how are they accessed? 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. Manage practice information, access staff training and complete attestation requirements. eviCores innovative SmartChoice program serves as a patient-outreach service that educateshealth plan members on available options for their advanced imaging procedure locations. Review claim status and request claim adjustments. Frequently asked questions about requesting authorization from eviCore healthcare Beginning Friday, December 18th at 5:00pm EST, you *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Annual Utilization Statistics | Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status There is a notion of utilization management being solely focused on cost savings. The associated preauthorization forms can be found here. Call Customer Service at 888-850-8526, 8 a.m. to 8 p.m., Monday through Sunday. How do I know when my test has been authorized? IMPORTANT: In the coming days, we will be migrating systems for our Part of it involves making sure the computer speaks the same language as the medical records. Pre-authorization - Regence endstream endobj startxref Fax all requests for services that require prior authorization to: Inpatient: 1-844-430-6806. To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers BCBSAZ-TPA co-administered plans (prefixes K8Y, K8Z, and NBT) . You can also see eviCore healthcare's criteria and get request forms at . 400 Buckwalter Place Blvd. You'll find more information on authorizations in the GEHA plan brochure. 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. Report Fraud & Abuse | Helpful Resources: Authorization Grids endobj Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. open positions so continue your job search at Cigna.com/careers, Something went wrong.Please try again after some time, Thank you for submitting. Hospitals should contact CareAllies at (800) 227-9360 to obtain prior authorization. In addition, some sites may require you to agree to their terms of use and privacy policy. Some authorization requirements vary by member contract. Directory Who to Contact for Preauthorization All providers must verify member eligibility and benefits prior to rendering non-emergency services. Todays Auth the Cuff podcast is talking really high-tech: artificial intelligence, natural language processing, statistical modeling, oh my! Forgot Password? stream Prior authorization fax: 800-267-8328 Behavioral health prior authorization fax: 877-840-5581. Which EHRs does eviCores intelliPath ePA support? Q1: Overall, how satisfied are you with eviCores website? The instructions on how to submit a case and a link to the correct portal to use will be provided. Intake form. PPO members You don't need to worry about referrals. Highmark recently launched the Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. 4 0 obj Please utilize our live chat feature which is available 7AM-7PM EST M-F. 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. PDF Visit www.evicore.com eviCore Pre-authorization Call 800.533.1206 What additional tools are available as add-on programs to the Cardiovascular solution? <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> endobj GHI Medicare non-City of New York. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. 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? Q1: Overall, how satisfied are you with eviCores website? Our network of quality providers offers an attractive option for health plansseeking to more appropriately manage radiology benefits. 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? 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. Were still hiring for other 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. eviCore positions. What is included in the Cardiovascular solution? *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * What is included in the Radiology solution? Username Password Register for an account Retrieve Username Retrieve Password What services are managed through the Musculoskeletal Surgical Program? Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Copyright 2022 eviCore healthcare. All Rights Reserved. we will be implementing changes to evicore.com in the near future. What is the fastest way to do this? What is included in the Specialty Drug solution? 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). 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. Why do we recommend conservative treatment options first? Note: Checking eligibility and benefits is key, butwe also have other resources to help you prepare. Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. If urgent (after-hours) call 866-322-6287 , from 9 p.m. to 9 a.m., Monday through Friday.
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