EmblemHealth Preauthorization List. Provider costs are reduced and decisions are communicated in real time, reducing delays. Beginning Friday, December 18th at 5:00pm EST, you Sometimes, a plan may require the member to request prior authorization for services. It speaks to the rapidly evolving healthcare industry, especially the increasing role of prior authorization and how providers can more effectively navigate it. reCAPTCHA is not valid; Please try again! 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. Directory Who to Contact for Preauthorization All providers must verify member eligibility and benefits prior to rendering non-emergency services. information about accessing the eviCore portal. All Rights Reserved. The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. 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. Prior authorization is required by eviCore healthcare for services performed for adult Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status IMPORTANT: In the coming days, we will be migrating systems for our Emily Coe, PhD interviews eviCore's Dr. Mary Kay Barton, Sr. Medical Director, Medical Oncology, and Dr. Gary Jones, Associate Medical Director, Medical Oncology, for an enlightening conversation on clinical trials in pediatric and adult oncology, treatment innovations, and more. 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. Simply, notify HAP within 48 hours of the emergency admission. Driving Directions 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. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. Which EHRs does eviCores intelliPath ePA support? Thank you for using eviCores website today! You can fax your authorization request to 1-800-217-9345. 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, Thank you for submitting information. Continue to Authorization Lookup Login Log In Forgot User ID? Continue to Authorization Lookup Login Log In Forgot User ID? Most PDF readers are a free download. Genetic Testing | Prior Authorized Utilization Review | Lab - eviCore Where are Musculoskeletal Program guidelines and how are they accessed? 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. CHCP - Resources - Sleep management - Cigna 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. Forgot Password? Hospital and Outpatient Services. PPO members You don't need to worry about referrals. PDF Requesting authorizations from eviCore - BCBSM Annual Utilization Statistics | What is included in the Cardiovascular solution? wont be able to apply to eviCore openings. Annual Utilization Statistics | Specialized therapies such as chiropractic, acupuncture, and physical therapy are cost effective, and can provide improved outcomes for chronic pain patients. What is the fastest way to do this? Usually, the provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider. 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. PDF evicore Post Acute FAQs - Johns Hopkins Medicine Emergency services are an exception. In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. If you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Fax 866-873-8279. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. Note: Checking eligibility and benefits is key, butwe also have other resources to help you prepare. Report Fraud & Abuse | Do you offer a mandatory prior authorization program for all sleep studies? . 1-800-624-0756 (TTY: 711) for HMO and Medicare Advantage benefits plans. Emergency room visits don't require prior authorization. Forgot Password? eviCores evidence-based Radiology Clinical guidelines are based upon major national and international association and society guidelines and criteria. 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. If you have any questions, call the number on the member's ID card. eviCore.com. Please use the BCBSAZ MA prior authorization fax form or the eviCore online request tool, available on the secure MA . Thank you for using eviCores website today! PDF Prior Authorization Requests - Quick Guide - AZBlue of authorization request(s). This podcast was created with the providers in mind. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Eligibility Verification Providers should verify member eligibility prior to requesting/providing services. eviCore Healthcare | Empowering the Improvement of Care Call 1-800-TALK-MVP (1-800-825-5687) to speak with an MVP representative. Or you can call Provider Services at . Multi-Factor Authentication (MFA) is now live on eviCores web portal! To view this file, you may need to install a PDF reader program. What services are managed through the Musculoskeletal Pain Management Program? of authorization request(s). The list applies to the following EmblemHealth lines of business: GHI Commercial non-City of New York. PDF Visit www.evicore.com eviCore Pre-authorization Call 800.533.1206 How will my doctor know where I am going? of authorization request(s). Prior authorization is required by Carelon Medical Benefits Management (formerly AIM . 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. wont be able to apply to eviCore openings. Q1: Overall, how satisfied are you with eviCores website? All Medicare authorization requests can be submitted using our general authorization form. 2 0 obj Preauthorization Lists | EmblemHealth How do I know when my test has been authorized? Fax: If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. 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). CHCP - Resources - Precertification - Cigna Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. : 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. reCAPTCHA is not valid; Please try again! Prior Authorizations & Precertifications | Cigna This is not an all-inclusive list. There is a notion of utilization management being solely focused on cost savings. Authorization number not appearing, unable to locate member, questions about clinical criteria screen. What is the fastest way to do this? Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status 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. 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). Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Register Now Utilization Management. \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). Available Trainings eviCore periodically will host orientation sessions for providers for various care categories. In keeping with DFS guidance, MetroPlusHealth's UM protocols resumed on June 22, 2020, including resuming issuing Prior Approvals and performing concurrent review. Why do we recommend conservative treatment options first? If you do not hear back from us within 5 business days, please call, Please enter provider primary location address. Note: Most out-of-network services require utilization management review. eviCore will communicate the determination utilizing the following methods: Report Fraud & Abuse | Prior authorization of a service is not a guarantee of payment of benefits. eviCore intelliPath . Terms of Use | *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * PDF Subject: Sign- up for eviCore Healthcare's Training for new Prior 0901, 0905-0907, 0913, 0917 Behavioral health treatment services. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. We start off todays podcast talking about echocardiograms, one of the coolest tests ever. What services are managed through the Musculoskeletal Surgical Program? endstream endobj 540 0 obj <. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Prescription drug prior authorization 24 hours a day, 7 days a week: 1-888-678-7015 Fax: 1-888-671-5285: . Contact J&B at 1-888-896-6233 or . The "Live Sessions" page will display. eviCore made it easy to complete my primary task online. Radiology Solution | Utilization Management | eviCore Provider Education -We interact with providers during implementation and on an ongoing basis to render support and educational resources, as well as obtain feedback for solution improvements. <> PDF Requesting Authorization from eviCore healthcare - FAQ - BCBSM 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. Login | Providers | Excellus BlueCross BlueShield 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. Care Management Programs Behavioral health. 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. Q1: Overall, how satisfied are you with eviCores website? Sessions offered May and June. Listen to our latest podcast episode with new host, Dr. Emily Coe featuring Dr. Mayank Shah. Were still hiring for other Certain outpatient procedures, services, supplies. To contact Customer Care, please call the phone number on the back of your Member ID Card. To view this file, you may need to install a PDF reader program. * 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. eviCore positions. Watch the latest Auth the Cuff podcast featuring Dr. Sid Govindan and John Young. Beginning Friday, December 18th at 5:00pm EST, you How does eviCore handle large gene panels? Finally, eviCore manages select cardiology and radiology services for dates of service prior to Oct. 1, 2018, including postservice requests. What can physical therapy do for my lower back pain? Member Rights Policy | eviCore.com 1-855-252-1117. All web users may now protect their portal accounts with an additional layer of security, including e-mail & SMS. While very useful when used appropriately, these studies have established some new guidelines to follow around this important test. Q4: How can eviCore make it easier for you to use this website? To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers The system can easily be made an extension of the clients existing claims workflow. Annual Utilization Statistics | If you have any questions about this notice, please the Prior Authorization Department at (646) 473-7446. As the chief medical officer of eviCore healthcare, a medical benefits management organization within Evernorth Health Services, Dr. Eric Gratias and his team work to ensure . We already use the eviCore portal. 539 0 obj <> endobj Online forms from eviCore's carriers hub MENU PROVIDERS About; Solutions. For quick reference, see the GEHA member's ID card. This new site may be offered by a vendor or an independent third party. Moreover, eviCore is the only company in the industry with dedicated, separately maintained pediatric guidelines. (This information should not be relied on as authorization for health care services and is not a guarantee of payment.). Member Rights Policy | Q4: How can eviCore make it easier for you to use this website? Why would I switch to intelliPath ePA? Call Center: eviCore's is available from 7 a.m. to 7 p.m. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * 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. What claims are subject to claims review? Availity provides administrative services to BCBSIL. <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Step 1 Confirm if Prior Authorization is Required. You are leaving this website/app (site). Copyright 2022Health Care Service Corporation. . Check eligibility and benefits for members. To request any additional assistance in accessing the guidelines, . Authorizations for HDHP, Standard and High Option members You will receive a letter in the mail and your physician will receive a letter via fax communicating this information. Medical Director -Cardiothoracic Surgeon -Remote - eviCore - Urgent Continue to Authorization Lookup Login Log In Forgot User ID? MCG Clinical Criteria- Information on Highmark's incorporation of MCG Health evidence-based clinical guidelines into Highmarks criteria of clinical decision support. Fax all requests for services that require prior authorization to: Inpatient: 1-844-430-6806. Please click here to register for an account. Were still hiring for other 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. stream What do I tell my patient when their case is denied? 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. E-Verify and IER Right to Work. 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. Manage practice information, access staff training and complete attestation requirements. Prior Authorization - BCBSAZ Health Choice Report Fraud & Abuse | Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Second, when requests reach a final status, the patient receives a letter indicating whether the request has been approved or denied. Please retain the confirmation email. . How do I obtain clinical certification for cardiovascular tests? 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. Portal Login Insights Blog eviCore Colorectal Screening Program Introducing eviCores new podcast Auth the Cuff! If urgent (after-hours) call 866-322-6287 , from 9 p.m. to 9 a.m., Monday through Friday. For commercialprior authorization requests handled by AIM Specialty Health(AIM): Commercial non-HMO prior authorization requests can be submitted to AIM intwo ways. 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! open positions so continue your job search at Cigna.com/careers. Service preapproval is based on the members benefit plan/eligibility at the time the service is reviewed/approved. Authorizations and PSODs | Provider | Priority Health BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. Provider Resource Center 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. The sleep management program does this by helping to ensure that appropriate sleep testing practices are followed and by supporting customers' use of PAP therapy. [{"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. eviCore made it easy to complete my primary task online. If the requested exam is denied, eviCore will notify both you and your physician and provide you with detailed appeal instructions. <> Certain employer groups may require prior authorization or pre-notification through other vendors. Hospitals should contact CareAllies at (800) 227-9360 to obtain prior authorization. All Rights Reserved. Effective 10/13/2017 - 12/31/2020. How does a computer make healthcare decisions? Beginning Friday, December 18th at 5:00pm EST, you Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. Provider Support | eviCore Please click here to register for an account. Q4: How can eviCore make it easier for you to use this website? So how do we continue to think about best practices for telehealth? 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. 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. Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. stream 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, External link You are leaving this website/app (site). We recognize that providers today navigate a complicated healthcare system while trying to make the best medical decisions for their patients. Helpful Resources: Authorization Grids Providers | Getting Started | Starting A New Prior Authorization - eviCore E-Verify and IER Right to Work. eviCore interacts with radiology patients in two ways. Ethics & Compliance | Prior Authorization | Blue Cross and Blue Shield of Illinois - BCBSIL If you are a Highmark network provider and have not signed up for NaviNet, learn how to do sohere. jandbmedical.com. 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. 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. Thank you for using eviCores website today! What additional tools are available as add-on programs to the Cardiovascular solution? First, our innovative SmartChoiceprogram serves as a patient-outreach service to educate health plan members on available options for their diagnostic imaging procedure locations. For more specific contact information, choose the statement below that best represents you. Sign in Learn more about electronic authorization Pre-authorization lists Commercial Another part is having access to an exceptionally large volume of historical cases. we will be implementing changes to evicore.com in the near future. open positions so continue your job search at Cigna.com/careers. Always check eligibility and benefits first,via theAvailityEssentialsor your preferred web vendor, prior to rendering care and services. Fraud Hotline. Services requiring prior authorization through eviCore are outlined below. How does eviCore communicate with the patients provider? 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. Please click here to register for an account. Contact us | Providers | Independence Blue Cross (IBX) 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. All Rights Reserved. The incredibly popular & eloquent nuclear stress test has been the subject of some recent studies on frequency. 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! Call 1-888-233-8158 from 8:00 a.m. to 9:00 p.m., Eastern, Monday through Friday. % 1 0 obj Tune into our new Auth the Cuff episode with eviCore's Dianne Doherty, Sr. . Tune into our recent podcast episode with eviCore's post-CAM program specialists Dr. Chanta Van Laanen, Dr. Laura Beitz-Walters and Dr. Mark Leichter to learn more. endstream endobj startxref This step will also help you determine if your services require prior authorization throughBCBSTXoreviCore. All Requests: Utilize Authorization Inquiry function in NaviNet. Contact Us | Blue Cross and Blue Shield of Illinois - BCBSIL :|gx7e#FB|+9?{RX7:!m$wCrrra4Ok2gfMrTsw 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.