Copyright 2022 eviCore healthcare. Review claim status and request claim adjustments. How do I obtain clinical certification for radiology tests? Contact J&B at 1-888-896-6233 or . Prior authorization fax: 800-267-8328 Behavioral health prior authorization fax: 877-840-5581. IMPORTANT: In the coming days, we will be migrating systems for our *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. ** Exception: Diabetic shoes and inserts are handled by Northwood, Inc . We already use the eviCore portal. 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. What can physical therapy do for my lower back pain? Apr 06, 2023. of authorization request(s). Should I reschedule? Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 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. Pharmacy Prior Authorization eviCore Medical Oncology Drug List What claims are subject to claims review? All web users may now protect their portal accounts with an additional layer of security, including e-mail & SMS. Bonus! PDF Subject: Sign- up for eviCore Healthcare's Training for new Prior eviCore intelliPath streamlines operations within a single easy-to-use application that integrates with major EHRs. The reality is, most providers weren't initially trained to deliver virtual care. 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. 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? 1-800-972-8382. "eviCore has over 1,100 doctors, therapists and nurses from a variety of specialties. 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). For more information about prior authorization, please review Mercy Care's Provider Manuals located under the Provider Information tab on our website. A prior authorization isnota guarantee of benefits or payment. endstream endobj startxref Terms of Use | $4d? vI [{"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. Driving Directions 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. Services billed with the following revenue codes always require prior authorization: 0240-0249 All-inclusive ancillary psychiatric. How does eviCore interact with Post-Acute Care patients? jandbmedical.com. If you have questions on a request handled by AIM or eviCore, call the appropriate vendor, as noted above. Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. Report Fraud & Abuse | Reminding and guiding patients to get the care they need. stream 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. All Rights Reserved. Thank you for using eviCores website today! E-Verify and IER Right to Work. First, our innovative SmartChoiceprogram serves as a patient-outreach service to educate health plan members on available options for their diagnostic imaging procedure locations. Manage practice information, access staff training and complete attestation requirements. The table will help you determine if you can use the approved prior authorization, modify the original or request a new one. of authorization request(s). We offer providers ongoing touch-pointsthat include a team dedicated to on-site visits; professional surveys; and the rigorous tracking and receiving of feedback from both providers and our clients. 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. How do I know when my test has been authorized? %PDF-1.6 % 4 0 obj 0901, 0905-0907, 0913, 0917 Behavioral health treatment services. CareCore National Web Portal Q1: Overall, how satisfied are you with eviCores website? Visit www.evicore.com Call 800.533.1206 Monday - Friday: 7:00 a.m. to 7:00 p.m. Authorizations and PSODs | Provider | Priority Health wont be able to apply to eviCore openings. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. 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. Username Password Register for an account Retrieve Username Retrieve Password Or . * 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. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Listen to our latest podcast episode with new host, Dr. Emily Coe featuring Dr. Mayank Shah. What is the fastest way to do this? ** Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. Contact Support | eviCore Support 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. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. information about accessing the eviCore portal. GHI Medicare non-City of New York. Contact Us | Blue Cross and Blue Shield of Illinois - BCBSIL wont be able to apply to eviCore openings. Register Now eviCore positions. Watch the latest Auth the Cuff podcast featuring Dr. Sid Govindan and John Young. Certain employer groups may require prior authorization or pre-notification through other vendors. Second, when requests reach a final status, the patient receives a letter indicating whether the request has been approved or denied. 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? reCAPTCHA is not valid; Please try again! endobj Sometimes, a plan may require the member to request prior authorization for services. 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. The diagnostic exams requiring prior authorization generally include the following procedures*: *prior authorization of certain procedures can vary by health plan. Thank you for using eviCores website today! Privacy Policy | Watch or listen to our new Auth the Cuff #podcast with Aaron Hackman and Lauren Kortmeyer, BSN, RN, from the radiology department at UCHealth, where we discuss the difference inclusive, conditionally-based guidelines have made for their nurses, clinicians, and patients. Additional information on authorizations can be found in Chapter 5 (Care & Quality Management) of the Highmark Provider Manual. For more specific contact information, choose the statement below that best represents you. Preauthorization Lists | EmblemHealth By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. Positron emission tomography computed tomography (PET-CT), Computed tomography angiography (CTA) scans, Non-OB ultrasound including head & neck, pediatric, breast, abdomen & retroperitoneum, extremity, arterial & venous, and gynecological, OB ultrasound including obstetrical ultrasounds and fetal echocardiography, eviCore currently maintains a nationwide advanced imaging network, featuring contracts with providers of imaging services in specific/predetermined locations. Utilization Management. You can also see eviCore healthcare's criteria and get request forms at . To view this file, you may need to install a PDF reader program. 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! Why is eviCore providing intelliPath ePA free of charge for eviCore-managed lives? So how do we continue to think about best practices for telehealth? Prior Authorizations | AmeriHealth Caritas North Carolina | Providers Box 30757 Salt Lake City, UT 84130-0757 Payer ID#: 87726 (EDI claims submission) Pharmacy 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. The site may also contain non-Medicare related information. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization. eviCore intelliPath . The field of gastroenterology is evolving. My procedure is scheduled soon and I havent heard if my case is approved or not. Todays Auth the Cuff podcast is talking really high-tech: artificial intelligence, natural language processing, statistical modeling, oh my! : 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. All Rights Reserved. The Role of Prior Authorization at eviCore | Evernorth Where are Musculoskeletal Program guidelines and how are they accessed? In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. Well before the pandemic, consumers were leaning towards home healthcare versus facility based care when appropriate for a number of reasons. eviCore positions. How does eviCore communicate with the patients provider? What services are managed through the Musculoskeletal Therapies Program? 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.