eviCore positions. endstream endobj startxref I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? Once a prior authorization request is received and processed, the decision is communicated to the provider. Q1: Overall, how satisfied are you with eviCores website? Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. 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, Specifically designed with the size and scale to address the complexity of our healthcare system today and tomorrow, eviCore is committed to advancing healthcare management through evidence-based medicine. eviCore positions. You can request an expedited appeal by calling the prior authorization number for the plan that covers your patient. 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). Clinical Resourcespage on theBCBSTX Medicaidwebsite. eviCore made it easy to complete my primary task online. Q4: How can eviCore make it easier for you to use this website? 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. 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. Most PDF readers are a free download. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. Electronic Data Interchange (EDI) Email: EDI@premera.com Helpful Resources: Authorization Grids 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. Copyright 2022 eviCore healthcare. Member Rights Policy | 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 Should I reschedule? All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. You can also see eviCore healthcare's criteria and get request forms at . Outpatient: 1-844-442-8012. 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. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. What is included in the Specialty Drug solution? <> Annual Utilization Statistics | of authorization request(s). Online - The eviCore Web Portal is available 24x7. Terms of Use | Please use the BCBSAZ MA prior authorization fax form or the eviCore online request tool, available on the secure MA . We already use the eviCore portal. Eligibility and benefits can be verified by accessing NaviNet or by calling the number on the back of the members identification card. Most PDF readers are a free download. Finally, eviCore manages select cardiology and radiology services for dates of service prior to Oct. 1, 2018, including postservice requests. Q4: How can eviCore make it easier for you to use this website? Medical knowledge is doubling faster than ever, as are advances on insights to access and treatment options for medical oncology. Usually, the provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider. 4. Sign in Learn more about electronic authorization Pre-authorization lists Commercial To contact Customer Care, please call the phone number on the back of your Member ID Card. Dont I have to go to a hospital for my procedure? 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. Listen to the new Auth the Cuff podcast for more information. Create an Account. Terms of Use | Ethics & Compliance | IMPORTANT: In the coming days, we will be migrating systems for our Report Fraud & Abuse | open positions so continue your job search at Cigna.com/careers, Were on a quest to improve the experience of administrators, clinicians, and patients who work with us. ** Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. 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. 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. Member Rights Policy | 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-1.6 % One option is Adobe Reader which has a built-in reader. BCBSAZ Health Choice requires all non-contracted dentists to obtain a Prior Authorization before rendering treatment. My procedure is scheduled soon and I havent heard if my case is approved or not. Call 1-800-TALK-MVP (1-800-825-5687) to speak with an MVP representative. What types of services are managed under your sleep solution? 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. Call Utilization Management at 855-339-8127, 9 a.m to 9 pm., Monday through Friday. Review claim status and request claim adjustments. open positions so continue your job search at Cigna.com/careers, Something went wrong.Please try again after some time, Thank you for submitting. Thank you for using eviCores website today! eviCore made it easy to complete my primary task online. 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. Please check directly with your health plan for specific requirements or contact eviCores Customer Service at (800) 918-8924. 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. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Fax all requests for services that require prior authorization to: Inpatient: 1-844-430-6806. of authorization request(s). eviCore will communicate the determination utilizing the following methods: 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. hbbd```b`` {dd"Xdw&e7eu"j`RH2f@d\B;IH~ 571 0 obj <>stream What do I do if a members eligibility is incorrect or not on file? Online forms from eviCore's carriers hub MENU PROVIDERS About; Solutions. 4 0 obj : 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. eviCore made it easy to complete my primary task online. 1-800-624-0756 (TTY: 711) for HMO and Medicare Advantage benefits plans. Services billed with the following revenue codes always require prior authorization: 0240-0249 All-inclusive ancillary psychiatric. Portal:The preferred - and fastest - method to submit preauthorization requests and receive approvals isNaviNet. Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. Privacy Policy | Beginning Friday, December 18th at 5:00pm EST, you Prior authorization fax: 800-267-8328 Behavioral health prior authorization fax: 877-840-5581. How did you get my phone number/information? If you are a Highmark network provider and have not signed up for NaviNet, learn how to do sohere. wont be able to apply to eviCore openings. Prior Authorization Automation. PNS contact tool. EmblemHealth Reduces Preauthoriz . Ethics & Compliance | Sometimes, a plan may require the member to request prior authorization for services. What services are managed through the Musculoskeletal Pain Management Program? Thank you for using eviCores website today! All Rights Reserved. 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. Terms of Use | Why would I switch to intelliPath ePA? Thank you for using eviCores website today! we will be implementing changes to evicore.com in the near future. Effective dates are subject to change. MCG Clinical Criteria- Information on Highmark's incorporation of MCG Health evidence-based clinical guidelines into Highmarks criteria of clinical decision support. ", Chief of Radiology & SVP of Medical Affairs. Contact your designated Independence Provider Network Services (PNS) team contact. 0901, 0905-0907, 0913, 0917 Behavioral health treatment services. The field of gastroenterology is evolving. Check eligibility and benefits for members. Many changes will take effect \u003cstrong\u003eJuly 6, 2023\u003c/strong\u003e. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Username Password Register for an account Retrieve Username Retrieve Password Q1: Overall, how satisfied are you with eviCores website? Terms of Use | View fee schedules, policies, and guidelines. Click herefor the MFA registration & setup guide. Description. Prescription drug prior authorization 24 hours a day, 7 days a week: 1-888-678-7015 Fax: 1-888-671-5285: . Report Fraud & Abuse | All Prior Authorizations can be submitted online, except the following: Must besubmitted via the appropriate fax line or by phone at 1-888-FIDELIS (1-888-343-3547): Urgent Requests o Initial Inpatient Rehabilitation can now be submitted online via provider portal o Inpatient Emergency Room Admission Requests Concurrent Requests Call 1 (800) 88CIGNA (882-4462). In general, there arethreestepsprovidersshould follow. Member Rights Policy | 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. Privacy Policy | Please click here to register for an account. -fUk23Hl\`U x@H2X"7"*,U D What is included in the Cardiovascular solution? Were still hiring for other Moreover, eviCore is the only company in the industry with dedicated, separately maintained pediatric guidelines. hb```|7@($qFqr&kX Q8rC%xd]ZG{5LA[K;:]*${;fR4kE[zGV@EFH;!Az. Receive support for technical or web portal related issue. Some procedures may also receive instant approval. Continue to Authorization Lookup Login Log In Forgot User ID? eviCore made it easy to complete my primary task online. Register Now Hospital and Outpatient Services. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. Well before the pandemic, consumers were leaning towards home healthcare versus facility based care when appropriate for a number of reasons. Prior authorization lookup tool. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Our proprietary integrated system, Claims Studio, delivers savings through an enhanced focus on accurate claims payment. 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). Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, CAR-T Cell Therapy & Medical Oncology Disparities, Crunching the Numbers! 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. Federal Employee Program (FEP ) Verify eligibility and benefits and/or check claim status for FEP members. Forgot Password? 888-482-8057 Mon.-Fri., 8am - 11pm ET Sat., 8am - 3pm ET. Some requests are handled by BCBSIL; others are handled by utilization management vendors. All Rights Reserved. Emergency services are an exception. Or . Directory Who to Contact for Preauthorization All providers must verify member eligibility and benefits prior to rendering non-emergency services. open positions so continue your job search at Cigna.com/careers. Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. . we will be implementing changes to evicore.com in the near future. BCBSAZ-TPA co-administered plans (prefixes K8Y, K8Z, and NBT) . Contact us Chat with us now. Privacy Policy | Apr 06, 2023. stream We would like to help. Some authorization requirements vary by member contract. eviCore positions. The site may also contain non-Medicare related information. 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. 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: Radiation Therapy: Call: 1 (866) 686-4452 . CareCore National, LLC d/b/a eviCore healthcare (eviCore) . Please click here to register for an account. Were still hiring for other Contact J&B at 1-888-896-6233 or . Please join us in reflecting back on the best moments from Auth the Cuff in 2020. First, our innovative SmartChoiceprogram serves as a patient-outreach service to educate health plan members on available options for their diagnostic imaging procedure locations. What types of cardiovascular procedures require prior authorization? The eviCore intelliPath. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. Why is eviCore providing intelliPath ePA free of charge for eviCore-managed lives? What is the fastest way to do this? I got a message from a SmartChoice representative asking me to call back; why are you calling me? What is included in the Medical Oncology program? E-Verify and IER Right to Work. The list applies to the following EmblemHealth lines of business: GHI Commercial non-City of New York. we will be implementing changes to evicore.com in the near future. ** Exception: Diabetic shoes and inserts are handled by Northwood, Inc . 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. Beginning Friday, December 18th at 5:00pm EST, you Emergency room visits don't require prior authorization. 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, An eviCore representative will review the information submitted to determine the next level of review for this request. 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. GEHA, like other federal medical plans, requires providers to obtain authorization before some services and procedures are performed. Learn more about the life-interrupting issue of back pain, and the long-term benefits of saving surgery for a last resort. E-Verify and IER Right to Work. Create an Account. Obtain prior authorizations through eviCore using one of the following methods: eviCoreperiodically will host orientation sessions for providers for various care categories. Fax an eviCore healthcare request form (available online) to 1-888-693-3210 Also, to ease the administrative burden of requiring prior authorization of OB Ultrasound studies, providers may batch service requests for up to 12 weeks and cases may be reviewed retrospectively for up to 3 business days following the date of service. To viewrequirements summaries andprocedure code lists, refer to theSupport Materials (Commercial)andSupport Materials (Government Programs)pages. 6 0 obj eviCores innovative SmartChoice program serves as a patient-outreach service that educateshealth plan members on available options for their advanced imaging procedure locations. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Beginning Friday, December 18th at 5:00pm EST, you eviCores evidence-based Radiology Clinical guidelines are based upon major national and international association and society guidelines and criteria. Meet Dr. Scarborough, Chief of Radiology & SVP of Medical Affairs. How do I obtain clinical certification for radiology tests? We recognize that providers today navigate a complicated healthcare system while trying to make the best medical decisions for their patients. Provider costs are reduced and decisions are communicated in real time, reducing delays. Step 2If prior authorization is required, have the following information ready: Step 3 Submit Your Prior Authorization Request. Benefits can vary; always confirm member coverage. Report Fraud & Abuse | Thank you for submitting information. Privacy Policy | To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers Step 1 Confirm if Prior Authorization is Required. This is not an all-inclusive list. What claims are subject to claims review? 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 Ethics & Compliance | What services are managed through the Musculoskeletal Therapies Program? PPO members You don't need to worry about referrals. Beginning Friday, December 18th at 5:00pm EST, you Remember, member benefits and review requirements will vary based on service/drug being rendered and individual/group policy elections. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status If you do not hear back from us within 5 business days, please call, Please enter provider primary location address. Were still hiring for other 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! How does my doctor access the Specialty Drug Management solution? :|gx7e#FB|+9?{RX7:!m$wCrrra4Ok2gfMrTsw E-Verify and IER Right to Work. 5 0 obj *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. Copyright 2022 eviCore healthcare. The Member Customer Care Center is open Monday-Friday, 8 am to 6 pm (ET). 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. services by chiropractors. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. Pharmacy Prior Authorization eviCore Medical Oncology Drug List 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. List. 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. The incredibly popular & eloquent nuclear stress test has been the subject of some recent studies on frequency. IMPORTANT: In the coming days, we will be migrating systems for our Telehealth, Telemedicine Hologram Care? Please click here to register for an account. open positions so continue your job search at Cigna.com/careers. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * All Medicare authorization requests can be submitted using our general authorization form. Were on a quest to improve the experience of administrators, clinicians, and patients who work with us. Highmark recently launched the Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. . Driving Directions If you have questions, call eviCore healthcare at . 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. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL.

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