Call Center: eviCore's is available from 7 a.m. to 7 p.m. Well before the pandemic, consumers were leaning towards home healthcare versus facility based care when appropriate for a number of reasons. One option is Adobe Reader which has a built-in reader. I need to change the date on my request. The reality is, most providers weren't initially trained to deliver virtual care. 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. eviCore currently maintains a nationwide advanced imaging network, featuring contracts with providers of imaging services in specific/predetermined locationsand as well as freestanding facilities. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * information about accessing the eviCore portal. The instructions on how to submit a case and a link to the correct portal to use will be provided. Thank you for using eviCores website today! To contact Customer Care, please call the phone number on the back of your Member ID Card. Annual Utilization Statistics | GHI Medicare non-City of New York. Beginning Friday, December 18th at 5:00pm EST, you 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. It speaks to the rapidly evolving healthcare industry, especially the increasing role of prior authorization and how providers can more effectively navigate it. 0 As a valued user of our website, we'd appreciate your feedback to help us improve your website experience. Most PDF readers are a free download. 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, Click herefor the MFA registration & setup guide. of authorization request(s). Our proprietary integrated system, Claims Studio, delivers savings through an enhanced focus on accurate claims payment. Register Now 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. eviCore positions. Call 1-800-TALK-MVP (1-800-825-5687) to speak with an MVP representative. 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. Please use the BCBSAZ MA prior authorization fax form or the eviCore online request tool, available on the secure MA . What can physical therapy do for my lower back pain? Forgot Password? Trials, Treatments, and Oncology Breakthroughs, Check Status of Existing Prior Authorization. Bonus! <> Always check eligibility and benefits first,via theAvailityEssentialsor your preferred web vendor, prior to rendering care and services. How do I know when my test has been authorized? Thank you for using eviCores website today! 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. We recognize that providers today navigate a complicated healthcare system while trying to make the best medical decisions for their patients. Services requiring prior authorization through eviCore are outlined below. Manage practice information, access staff training and complete attestation requirements. Please click here to register for an account. EmblemHealth Reduces Preauthoriz . Terms of Use | Why do we recommend conservative treatment options first? * 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. Contact your designated Independence Provider Network Services (PNS) team contact. How do I obtain clinical certification for radiology tests? Prior authorization is required by eviCore healthcare for services performed for adult 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. Eligibility and benefits can be verified by accessing NaviNet or by calling the number on the back of the members identification card. Copyright 2022 eviCore healthcare. eviCore positions. To check on the status of an authorization, please visit our provider secure web portal. 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! See Clinical Corner for services that require Preauthorization. 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? Q4: How can eviCore make it easier for you to use this website? Report Fraud & Abuse | Specialized therapies such as chiropractic, acupuncture, and physical therapy are cost effective, and can provide improved outcomes for chronic pain patients. 410 N. 44th Street, Suite 900. All Rights Reserved. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Copyright 2022 eviCore healthcare. Q4: How can eviCore make it easier for you to use this website? In some instances repeat exams for condition treatment or management will require prior authorization. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, CAR-T Cell Therapy & Medical Oncology Disparities, Crunching the Numbers! we will be implementing changes to evicore.com in the near future. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? 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! You're being redirected to the CMS search site. To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers One option is Adobe Reader which has a built-in reader. What is included in the Cardiovascular solution? 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. IMPORTANT: In the coming days, we will be migrating systems for our 5 0 obj Q4: How can eviCore make it easier for you to use this website? eviCore positions. 3 0 obj Or . Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status For commercialprior authorization requests handled by AIM Specialty Health(AIM): Commercial non-HMO prior authorization requests can be submitted to AIM intwo ways. endobj How does eviCore interact with Post-Acute Care patients? All Rights Reserved. Simply, notify HAP within 48 hours of the emergency admission. Annual Utilization Statistics | 1-800-972-8382. Terms of Use | hbbd```b`` {dd"Xdw&e7eu"j`RH2f@d\B;IH~ We start off todays podcast talking about echocardiograms, one of the coolest tests ever. Online - The eviCore Web Portal is available 24x7. 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. 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. This step will also help you determine if your services require prior authorization throughBCBSTXoreviCore. Q1: Overall, how satisfied are you with eviCores website? Check status of submitted authorizations. %%EOF Box 30757 Salt Lake City, UT 84130-0757 Payer ID#: 87726 (EDI claims submission) Pharmacy The online portal is designed to facilitate the processing ofauthorizationrequests in a timely, efficient manner. It indicates which codes are handled by a vendor. How does eviCore handle large gene panels? External link You are leaving this website/app (site). Watch this weeks episode of Auth the Cuff to learn more! What digital resources can I access to find out more information? eviCores approach is not to deny care that is needed but rather to redirect providers and patients to more appropriate testing and treatment options, which helps ensure safety and maximize value. please email the case number and request to: reqcriteria@eviCore.com. Benefit plans vary widely and are subject to change based on the contract effective dates. For additional resources on the Helion Arc authorization process, includinginstructionalvideos,CLICK HERE. By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. Ethics & Compliance | Listen to our latest podcast episode with new host, Dr. Emily Coe featuring Dr. Mayank Shah. The site may also contain non-Medicare related information. <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. In addition, some sites may require you to agree to their terms of use and privacy policy. Behavioral health. Outpatient: 1-844-442-8012. You can also see eviCore healthcare's criteria and get request forms at . What is included in eviCores Comprehensive Oncology program? 1-888-MDAETNA (1-888-632-3862) (TTY: 711) for all other plans. Why was my test, treatment, or procedures not approved? 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, 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. The site may also contain non-Medicare related information. Care Management Programs Please click here to register for an account. And its provided as a free service for eviCore-managed case volume. 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. eviCore intelliPath streamlines operations within a single easy-to-use application that integrates with major EHRs. Service preapproval is based on the members benefit plan/eligibility at the time the service is reviewed/approved. Frequently asked questions about requesting authorization from eviCore healthcare All web users may now protect their portal accounts with an additional layer of security, including e-mail & SMS. GEHA, like other federal medical plans, requires providers to obtain authorization before some services and procedures are performed. Blue Cross and Blue Shield of Texas (BCBSTX) has contracted witheviCore healthcare (eviCore)*to provide certain utilization management prior authorization services for our government programs. . Benefits can vary; always confirm member coverage. Fax all requests for services that require prior authorization to: Inpatient: 1-844-430-6806. How does a computer make healthcare decisions? I got a message from a SmartChoice representative asking me to call back; why are you calling me? Copyright 2022 eviCore healthcare. IMPORTANT: In the coming days, we will be migrating systems for our . Were still hiring for other Privacy Policy | of authorization request(s). You will receive a letter in the mail and your physician will receive a letter via fax communicating this information. Terms of Use | 1-888-693-3211 (TTY: 711). What claims are subject to claims review? Beginning Friday, December 18th at 5:00pm EST, you You can verify benefits and request prior authorization at Availity.com or by phone at 1-888-693-3211 1-888-693-3211. In practice, utilization management plays a large role in patient safety and empowerment. Please utilize our live chat feature which is available 7AM-7PM EST M-F. Ethics & Compliance | we will be implementing changes to evicore.com in the near future. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status If you have any questions about this notice, please the Prior Authorization Department at (646) 473-7446. jandbmedical.com. If you are a Highmark network provider and have not signed up for NaviNet, learn how to do sohere. Thank you for using eviCores website today! If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) prior to performing the procedure or service. You can fax your authorization request to 1-800-217-9345. Member Rights Policy | Todays Auth the Cuff podcast is talking really high-tech: artificial intelligence, natural language processing, statistical modeling, oh my! If you have any questions, call the number on the member's ID card. 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. Electronic Data Interchange (EDI) Email: EDI@premera.com Report Fraud & Abuse | Helpful Resources: Authorization Grids What are my options when a case is denied? Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. Sign in Learn more about electronic authorization Pre-authorization lists Commercial Contact J&B at 1-888-896-6233 or . Eligibility Verification Providers should verify member eligibility prior to requesting/providing services. Terms of Use | 2 0 obj reCAPTCHA is not valid; Please try again! reCAPTCHA is not valid; Please try again! The incredibly popular & eloquent nuclear stress test has been the subject of some recent studies on frequency. 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. Q4: How can eviCore make it easier for you to use this website? Please click here to register for an account. Our hosts Dr. Torelli and Liz Avila are here to explain why. Were still hiring for other of authorization request(s). Please join us in reflecting back on the best moments from Auth the Cuff in 2020. 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. To viewrequirements summaries andprocedure code lists, refer to theSupport Materials (Commercial)andSupport Materials (Government Programs)pages. 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. % Portal Login Insights Blog eviCore Colorectal Screening Program Were still hiring for other Some authorization requirements vary by member contract. open positions so continue your job search at Cigna.com/careers. Radiation Therapy: Call: 1 (866) 686-4452 . Echocardiograms also just so happen to be one of the most common inappropriately ordered tests. eviCores evidence-based Radiology Clinical guidelines are based upon major national and international association and society guidelines and criteria. Report Fraud & Abuse | 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. The "Live Sessions" page will display. Beginning Friday, December 18th at 5:00pm EST, you Privacy Policy | Please retain the confirmation email. 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. You might find that the answer is simpler than you think! What do I do if a members eligibility is incorrect or not on file? 539 0 obj <> endobj As a valued user of our website, wed appreciate your feedback to help us improve your website experience. eviCore made it easy to complete my primary task online. Refer to the Procedures that require authorization by eviCore healthcaredocument for more details. Copyright 2022 eviCore healthcare. What do I tell my patient when their case is denied? 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). 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, First, our innovative SmartChoiceprogram serves as a patient-outreach service to educate health plan members on available options for their diagnostic imaging procedure locations. of authorization request(s). Refer to the March 30, 2023, provider notice (PDF) for more information and to register for training based on your physicians specialty.

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