We start off todays podcast talking about echocardiograms, one of the coolest tests ever. Behavioral health. Bluffton, SC 29910 Information for Blue Cross and Blue Shield of Illinois (BCBSIL) members is found onour member site. Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) prior to performing the procedure or service. Additional information about the programs and links to prior authorization codes are available under Care Management Programs in the left website menu. Copyright 2022 eviCore healthcare. 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. Please retain the confirmation email. Simply, notify HAP within 48 hours of the emergency admission. Or you can call Provider Services at . Contact your designated Independence Provider Network Services (PNS) team contact. endobj With a PPO plan, you have the flexibility to seek care from doctors in and out of the network. We recognize that providers today navigate a complicated healthcare system while trying to make the best medical decisions for their patients. Preauthorization Lists New Empire Precertification Requ . Prescription drug prior authorization 24 hours a day, 7 days a week: 1-888-678-7015 Fax: 1-888-671-5285: . 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). eviCore positions. What if the request does not meet clinical criteria? Forgot Password? If the requested exam is denied, eviCore will notify both you and your physician and provide you with detailed appeal instructions. We would like to help. <> 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. Q1: Overall, how satisfied are you with eviCores website? eviCore currently maintains a nationwide advanced imaging network, featuring contracts with providers of imaging services in specific/predetermined locationsand as well as freestanding facilities. reCAPTCHA is not valid; Please try again! 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. %%EOF Examples of services that may require authorization include the following. Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST. Provider costs are reduced and decisions are communicated in real time, reducing delays. eviCore positions. Refer to the March 30, 2023, provider notice (PDF) for more information and to register for training based on your physicians specialty. Check eligibility and benefits for members. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. we will be implementing changes to evicore.com in the near future. 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. ", Chief of Radiology & SVP of Medical Affairs. In practice, utilization management plays a large role in patient safety and empowerment. Call Utilization Management at 855-339-8127, 9 a.m to 9 pm., Monday through Friday. This new site may be offered by a vendor or an independent third party. % Please complete the Dental Specialty Referral Request Form and fax to 480-350-2217, email to: [email protected], or mail to: BCBSAZ Health Choice, Inc. Attn: Dental Prior Authorization. For commercialprior authorization requests handled by AIM Specialty Health(AIM): Commercial non-HMO prior authorization requests can be submitted to AIM intwo ways. 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. IMPORTANT: In the coming days, we will be migrating systems for our See Clinical Corner for services that require Preauthorization. The reality is, most providers weren't initially trained to deliver virtual care. 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. * 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. Please click here to register for an account. 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! . We already use the eviCore portal. eviCore positions. Our network of quality providers offers an attractive option for health plansseeking to more appropriately manage radiology benefits. Service preapproval is based on the members benefit plan/eligibility at the time the service is reviewed/approved. Some procedures may also receive instant approval. This step will also help you determine if your services require prior authorization throughBCBSTXoreviCore. of authorization request(s). To contact Customer Care, please call the phone number on the back of your Member ID Card. 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. Emergency services are an exception. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. For inpatient hospital stays, your doctor will get prior authorization from HAP. E-Verify and IER Right to Work. Moreover, eviCore is the only company in the industry with dedicated, separately maintained pediatric guidelines. All Rights Reserved. Fax (24-hour) at 866-809-1370 . The field of gastroenterology is evolving. Sessions offered May and June. endstream endobj 540 0 obj <. Register Now Member Rights Policy | You can also see eviCore healthcare's criteria and get request forms at . Manage practice information, access staff training and complete attestation requirements. 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). Description. Benefits > CHS Group Information" or call the prior authorization phone number on back of the member's ID card. All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. open positions so continue your job search at Cigna.com/careers. Helpful Resources: Authorization Grids Apr 06, 2023. Moving forward, please visit CoverMyMeds or via SureScripts in your EHR to learn more and submit all new PA requests electronically. Learn more about the life-interrupting issue of back pain, and the long-term benefits of saving surgery for a last resort. IMPORTANT: In the coming days, we will be migrating systems for our All Requests: Utilize Authorization Inquiry function in NaviNet. Watch this weeks episode of Auth the Cuff to learn more! Obtain prior authorizations through eviCore using one of the following methods: eviCoreperiodically will host orientation sessions for providers for various care categories. A prior authorization isnota guarantee of benefits or payment. Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. Sometimes, a plan may require the member to request prior authorization for services. Were on a quest to improve the experience of administrators, clinicians, and patients who work with us. Prior authorization fax: 800-267-8328 Behavioral health prior authorization fax: 877-840-5581. How does eviCore interact with radiology patients? open positions so continue your job search at Cigna.com/careers, Something went wrong.Please try again after some time, Thank you for submitting. stream 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. eviCore.com 1-855-252-1117. 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. Effective dates are subject to change. Report concerns to the BCBSIL Special Investigations Department (SID) Fraud website 1 . 5 0 obj Medical knowledge is doubling faster than ever, as are advances on insights to access and treatment options for medical oncology. Forgot Password? Trials, Treatments, and Oncology Breakthroughs, Check Status of Existing Prior Authorization. 1-888-693-3211 (TTY: 711). The procedure codes contained in the lists below usually require authorization (based on the members benefit plan/eligibility). eviCores Radiology solution delivers cost savings and improved patient outcomes by ensuring health plan members receive the appropriate test or treatment necessary for their individual case presentation or condition. Online - The eviCore Web Portal is available 24x7. Second, when requests reach a final status, the patient receives a letter indicating whether the request has been approved or denied. 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. Check eligibility and benefits for members. Please click here to register for an account. Inpatient Planned Requests: Call Highmark Clinical Services; Press 2 for authorization requirements/ status. How does eviCore handle large gene panels? *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> All Rights Reserved. Copyright 2022Health Care Service Corporation. Services requiring prior authorization through eviCore are outlined below. Todays Auth the Cuff podcast is talking really high-tech: artificial intelligence, natural language processing, statistical modeling, oh my! Please click here to register for an account. eviCore healthcare (eviCore) Obtain benefit preauthorization for certain care categories. If you do not hear back from us within 5 business days, please call, Please enter provider primary location address. Report Fraud & Abuse | Please utilize our live chat feature which is available 7AM-7PM EST M-F. Terms of Use | Q1: Overall, how satisfied are you with eviCores website? Prior authorization requests for our Blue Cross Medicare Advantage (PPO)SM(MA PPO), Blue Cross Community Health PlansSM(BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SMmembers can be submitted to eviCore in two ways. of authorization request(s). CareCore National, LLC d/b/a eviCore healthcare (eviCore) . The online portal is designed to facilitate the processing ofauthorizationrequests in a timely, efficient manner. reCAPTCHA is not valid; Please try again! 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. 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. eviCore.com. 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. How do I know when my test has been authorized? 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, Ethics & Compliance | hbbd```b`` {dd"Xdw&e7eu"j`RH2f@d\B;IH~ Were still hiring for other Review claim status and request claim adjustments. Effective 10/13/2017 - 12/31/2020. How do I obtain clinical certification for cardiovascular tests? Annual Utilization Statistics | 400 Buckwalter Place Blvd. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 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. 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. For more specific contact information, choose the statement below that best represents you. 1-800-972-8382. You may also go directly to eviCore's self-service web portal at www.evicore.com. What services are managed through the Musculoskeletal Therapies Program? As a valued user of our website, we'd appreciate your feedback to help us improve your website experience. Certain outpatient procedures, services, supplies. eviCore made it easy to complete my primary task online. Their sole job is to ensure patients get the best possible care. open positions so continue your job search at Cigna.com/careers. Thank you for submitting information. services by chiropractors. Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. hb```|7@($qFqr&kX Q8rC%xd]ZG{5LA[K;:]*${;fR4kE[zGV@EFH;!Az. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. Fax 866-873-8279. I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? Usually, the provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider. %PDF-1.6 % Continue to Authorization Lookup Login Log In Forgot User ID? Use the link and toll-free phone number to access your training. IMPORTANT: In the coming days, we will be migrating systems for our For additional resources on the Helion Arc authorization process, includinginstructionalvideos,CLICK HERE. Our proprietary integrated system, Claims Studio, delivers savings through an enhanced focus on accurate claims payment. So how do we continue to think about best practices for telehealth? Why didn't you call me the last time I had a procedure? IMPORTANT: In the coming days, we will be migrating systems for our 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. Privacy Policy | Why was my test, treatment, or procedures not approved? In keeping with DFS guidance, MetroPlusHealth's UM protocols resumed on June 22, 2020, including resuming issuing Prior Approvals and performing concurrent review. What types of cardiovascular procedures require prior authorization? If you need preauthorization, contact eviCore in one of three ways: Get immediate approval by submitting your request at www.evicore.com. Frequently asked questions about requesting authorization from eviCore healthcare reCAPTCHA is not valid; Please try again! What can chiropractic services do for my lower back pain? Once a prior authorization request is received and processed, the decision is communicated to the provider. 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. 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. For more information about prior authorization, please review Mercy Care's Provider Manuals located under the Provider Information tab on our website. An eviCore representative will review the information submitted to determine the next level of review for this request. \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). Copyright 2022 eviCore healthcare. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * IMPORTANT: In the coming days, we will be migrating systems for our View fee schedules, policies, and guidelines. of authorization request(s). Prior authorization is required by eviCore healthcare for services performed for adult GHI Medicare non-City of New York. Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. Remember, member benefits and review requirements will vary based on service/drug being rendered and individual/group policy elections. What do I tell my patient when their case is denied? To view this file, you may need to install a PDF reader program. It speaks to the rapidly evolving healthcare industry, especially the increasing role of prior authorization and how providers can more effectively navigate it. Terms of Use | Call Customer Service at 888-850-8526, 8 a.m. to 8 p.m., Monday through Sunday. Should I reschedule? If urgent (after-hours) call 866-322-6287 , from 9 p.m. to 9 a.m., Monday through Friday. information about accessing the eviCore portal. Register Now This information is intended to serve as a reference summary that outlines where information about Highmarks authorization requirements can be found. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * 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. Fax all requests for services that require prior authorization to: Inpatient: 1-844-430-6806. Which EHRs does eviCores intelliPath ePA support? Q4: How can eviCore make it easier for you to use this website? Copyright 2022 eviCore healthcare. Q1: Overall, how satisfied are you with eviCores website? Please click here to register for an account. Federal Employee Program (FEP ) Verify eligibility and benefits and/or check claim status for FEP members. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status In addition, they face growing administrative burdens. Annual Utilization Statistics | Annual Utilization Statistics | How does my doctor access the Specialty Drug Management solution? Report Fraud & Abuse | please email the case number and request to: [email protected]. Terms of Use | Copyright 2022 eviCore healthcare. 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. . eviCores evidence-based Radiology Clinical guidelines are based upon major national and international association and society guidelines and criteria. endobj You'll find more information on authorizations in the GEHA plan brochure. 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. In general, there arethreestepsprovidersshould follow. How will prior authorization determinations be communicated? Note: Checking eligibility and benefits is key, butwe also have other resources to help you prepare. 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). As a valued user of our website, wed appreciate your feedback to help us improve your website experience. 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. Prior authorization is required by Carelon Medical Benefits Management (formerly AIM . Register Now You will be contacted by an eviCore representative within 5 business days. <>>> This new site may be offered by a vendor or an independent third party. Effective May 1, 2023, AmeriHealth Caritas North Carolina (ACNC) will require prior authorization via eviCore healthcare for selected health care services. The "Live Sessions" page will display. 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: Refer to the Procedures that require authorization by eviCore healthcaredocument for more details. Q4: How can eviCore make it easier for you to use this website? *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * endstream endobj startxref You can fax your authorization request to 1-800-217-9345. 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 made it easy to complete my primary task online. 410 N. 44th Street, Suite 900. stream Dont I have to go to a hospital for my procedure? 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. wont be able to apply to eviCore openings. Review claim status and request claim adjustments. Hospitals should contact CareAllies at (800) 227-9360 to obtain prior authorization. What services are managed through the Musculoskeletal Surgical Program? 1 0 obj open positions so continue your job search at Cigna.com/careers. Thank you for using eviCores website today! Privacy Policy | All Rights Reserved. Visit www.evicore.com Call 800.533.1206 Monday - Friday: 7:00 a.m. to 7:00 p.m. Credentialing Credentialing and joining our network - 1-800-353-1232 (TTY: 711) Special programs and other phone numbers Availity help - registration questions, help with user name/password - 1-800-282-4548 . Please click here to register for an account. What types of radiology procedures require prior authorization? The diagnostic exams requiring prior authorization generally include the following procedures*: *prior authorization of certain procedures can vary by health plan. External link You are leaving this website/app (site). Care Management Programs Use the Prior Authorization Crosswalk Table when you have an approved prior authorization for treating a UnitedHealthcare commercial member and need to provide an additional or different service. Q4: How can eviCore make it easier for you to use this website? Member Rights Policy | -fUk23Hl\`U x@H2X"7"*,U D If you have questions on a request handled by AIM or eviCore, call the appropriate vendor, as noted above. Phone Number 1.800.646.0418 x20136 Email [email protected] Affiliations Stay Updated With Our Provider Newsletter Your email address Website Feedback Thank you for using eviCore's website today! Beginning Friday, December 18th at 5:00pm EST, you Mailing address. wont be able to apply to eviCore openings. Echocardiograms also just so happen to be one of the most common inappropriately ordered tests. 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. Member Rights Policy | MEDICAL POLICIES The incredibly popular & eloquent nuclear stress test has been the subject of some recent studies on frequency. Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. For many services, we manage the precertification process directly. 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.
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