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. All Rights Reserved. The Role of Prior Authorization at eviCore | Evernorth Privacy Policy | Beginning Friday, December 18th at 5:00pm EST, you 1-800-972-8382. 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. Clinical guidelines are becoming increasingly necessary to get proper testing, but not all guidelines are created equal. Online Forms | Providers Hub | eviCore - Prior Authorizations The field of gastroenterology is evolving. endobj Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, CAR-T Cell Therapy & Medical Oncology Disparities, Crunching the Numbers! <> This new site may be offered by a vendor or an independent third party. Telehealth, Telemedicine Hologram Care? If you do not hear back from us within 5 business days, please call, Please enter provider primary location address. If you have questions on a request handled by AIM or eviCore, call the appropriate vendor, as noted above. wont be able to apply to eviCore openings. Note: Most out-of-network services require utilization management review. Find Contact Information; Podcasts; GO TO PROVIDER'S HUB. How does eviCore handle large gene panels? 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. reCAPTCHA is not valid; Please try again! of authorization request(s). Thank you for using eviCores website today! Please click here to register for an account. Copyright 2022 eviCore healthcare. This new site may be offered by a vendor or an independent third party. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. What claims are subject to claims review? 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. 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. PDF Visit www.evicore.com eviCore Pre-authorization Call 800.533.1206 Radiation Therapy: Call: 1 (866) 686-4452 . Contact Us; Search. What is included in the Radiation Oncology program? In addition, they face growing administrative burdens. The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. Call Customer Service at 888-850-8526, 8 a.m. to 8 p.m., Monday through Sunday. To request any additional assistance in accessing the guidelines, . 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. External link You are leaving this website/app (site). (This information should not be relied on as authorization for health care services and is not a guarantee of payment.). "eviCore has over 1,100 doctors, therapists and nurses from a variety of specialties. Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. How do I obtain clinical certification for cardiovascular tests? How did you get my phone number/information? 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. 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. Where are Musculoskeletal Program guidelines and how are they accessed? eviCore.com 1-855-252-1117. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Member Rights Policy | GHI Medicare non-City of New York. Beginning Friday, December 18th at 5:00pm EST, you 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, IMPORTANT: In the coming days, we will be migrating systems for our To view this file, you may need to install a PDF reader program. Privacy Policy | PDF Prior Authorization Requests - Quick Guide - AZBlue Apr 06, 2023. Ethics & Compliance | Providers who do not have NaviNet,can use the HIPAA Health Services Review (278) electronic transactions for some types of authorizations. Copyright 2022 eviCore healthcare. 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). %PDF-1.5 In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. IMPORTANT: In the coming days, we will be migrating systems for our How does eviCore interact with providers? Check eligibility and benefits for members. Health Care Providers | BCBS of Tennessee Prior Authorization | 1199SEIU Funds eviCore positions. 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. Effective May 1, 2023, AmeriHealth Caritas North Carolina (ACNC) will require prior authorization via eviCore healthcare for selected health care services. MCG Clinical Criteria- Information on Highmark's incorporation of MCG Health evidence-based clinical guidelines into Highmarks criteria of clinical decision support. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status eviCore made it easy to complete my primary task online. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. The site may also contain non-Medicare related information. If urgent (after-hours) call 866-322-6287 , from 9 p.m. to 9 a.m., Monday through Friday. Care Management Programs Do you ever ask the question about why you might need that MRI or CT scan? Authorization number not appearing, unable to locate member, questions about clinical criteria screen. Authorizations/Precertifications | GEHA As a valued user of our website, wed appreciate your feedback to help us improve your website experience. 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 . There is a notion of utilization management being solely focused on cost savings. Prior Authorization and Notification | UHCprovider.com 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). Fax the request form to 888.647.6152. Thank you for using eviCores website today! Create an Account. See Clinical Corner for services that require Preauthorization. What types of cardiovascular procedures require prior authorization? Prior Authorizations & Precertifications | Cigna So how do we continue to think about best practices for telehealth? As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Forgot Password? . wont be able to apply to eviCore openings. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. Contact us Chat with us now. Privacy Policy | Meet Dr. Scarborough, Chief of Radiology & SVP of Medical Affairs. Pre-authorization - Regence Copyright 2022Health Care Service Corporation. What can physical therapy do for my lower back pain? The eviCore intelliPath. Once a prior authorization request is received and processed, the decision is communicated to the provider. How does a provider check the prior authorization status for a member? Step 2If prior authorization is required, have the following information ready: Step 3 Submit Your Prior Authorization Request. % What is the fastest way to do this? You will be contacted by an eviCore representative within 5 business days. eviCore positions. Learn more about the life-interrupting issue of back pain, and the long-term benefits of saving surgery for a last resort. EmblemHealth Reduces Preauthoriz . What services are managed through the Musculoskeletal Pain Management Program? Services requiring prior authorization through eviCore are outlined below. Review claim status and request claim adjustments. All Requests: Utilize Authorization Inquiry function in NaviNet. PNS contact tool. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Contact Support | eviCore Support 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 Most PDF readers are a free download. 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. 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. To check on the status of an authorization, please visit our provider secure web portal. If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. A prior authorization isnota guarantee of benefits or payment. For quick reference, see the GEHA member's ID card. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 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 CareCore National Web Portal Do you offer a mandatory prior authorization program for all sleep studies? 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). Beginning Friday, December 18th at 5:00pm EST, you Helpful Resources: Authorization Grids Register Now 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. Benefits can vary; always confirm member coverage. reCAPTCHA is not valid; Please try again! Some authorization requirements vary by member contract. 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. Trials, Treatments, and Oncology Breakthroughs, Check Status of Existing Prior Authorization. Prior authorization is required by eviCore healthcare for services performed for adult Directory Who to Contact for Preauthorization All providers must verify member eligibility and benefits prior to rendering non-emergency services. eviCore.com. reCAPTCHA is not valid; Please try again! All Rights Reserved. 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. How does my doctor access the Specialty Drug Management solution? we will be implementing changes to evicore.com in the near future. Please join us in reflecting back on the best moments from Auth the Cuff in 2020. The "Live Sessions" page will display. Use theAvailityProvider Portalor your preferred vendor to check eligibility and benefits before rendering services. How do I obtain clinical certification for radiology tests? Username Password Register for an account Retrieve Username Retrieve Password Referrals and prior authorizations | Michigan Health Insurance | HAP Ethics & Compliance | Their sole job is to ensure patients get the best possible care. -fUk23Hl\`U x@H2X"7"*,U D What if the request does not meet clinical criteria? Thank you for using eviCores website today! If you do not remember your password, please click "Retrieve Password" below. 3 0 obj ", Chief of Radiology & SVP of Medical Affairs. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. 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. I need to change the CPT code on my request. Copyright 2022 eviCore healthcare. 4. Terms of Use | Portal:The preferred - and fastest - method to submit preauthorization requests and receive approvals isNaviNet. What do I do if a members eligibility is incorrect or not on file? 560 0 obj <>/Filter/FlateDecode/ID[<8C57985C8CBDD144A535DF79903CF9DC>]/Index[539 33]/Info 538 0 R/Length 105/Prev 288900/Root 540 0 R/Size 572/Type/XRef/W[1 3 1]>>stream Hospitals should contact CareAllies at (800) 227-9360 to obtain prior authorization. Beginning Friday, December 18th at 5:00pm EST, you Subject: Sign- up for eviCore Healthcare's Training for new Prior Authorization requirements! For inpatient hospital stays, your doctor will get prior authorization from HAP. 0901, 0905-0907, 0913, 0917 Behavioral health treatment services. 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, eviCore made it easy to complete my primary task online. This is not an all-inclusive list. Annual Utilization Statistics | Or you can call Provider Services at . *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * 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. The terms of the members plan control the available benefits. Prior Authorization Automation. Health Plans. What is included in the Radiology solution? Sessions offered May and June. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. CHCP - Resources - Sleep management - Cigna Bonus! PPO members You don't need to worry about referrals. This podcast was created with the providers in mind. [{"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. <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> This step will also help you determine if your services require prior authorization throughBCBSTXoreviCore. Examples of services that may require authorization include the following. Simply visit the eviCores Providers Hub page and select the health plan and solution option for your case in the training section. BCBSAZ-TPA co-administered plans (prefixes K8Y, K8Z, and NBT) . Moreover, eviCore is the only company in the industry with dedicated, separately maintained pediatric guidelines. PDF Services that require authorization for Michigan providers - BCBSM Provider Authorization - MetroPlusHealth 1-888-693-3211 (TTY: 711). eviCore positions. Register Now Prior authorization fax: 800-267-8328 Behavioral health prior authorization fax: 877-840-5581. ** Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. Echocardiograms also just so happen to be one of the most common inappropriately ordered tests. All web users may now protect their portal accounts with an additional layer of security, including e-mail & SMS. eviCore positions. 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. I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? Driving Directions Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Check Status of Existing Prior Authorization. BCBSAZ Health Choice requires all non-contracted dentists to obtain a Prior Authorization before rendering treatment. Register Now Certain employer groups may require prior authorization or pre-notification through other vendors. 400 Buckwalter Place Blvd. 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 is included in eviCores Comprehensive Oncology program? eviCore will communicate the determination utilizing the following methods: Preauthorization | Blue Cross & Blue Shield of Rhode Island An eviCore representative will review the information submitted to determine the next level of review for this request. 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. of authorization request(s). While very useful when used appropriately, these studies have established some new guidelines to follow around this important test. Some requests are handled by BCBSIL; others are handled by utilization management vendors. endobj Call Utilization Management at 855-339-8127, 9 a.m to 9 pm., Monday through Friday. of authorization request(s). Sometimes, a plan may require the member to request prior authorization for services. I need to change the date on my request. Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. The table will help you determine if you can use the approved prior authorization, modify the original or request a new one. 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. Q1: Overall, how satisfied are you with eviCores website? The site may also contain non-Medicare related information. The list applies to the following EmblemHealth lines of business: GHI Commercial non-City of New York. Available Trainings eviCore periodically will host orientation sessions for providers for various care categories. Create an Account. Contact us | Providers | Independence Blue Cross (IBX) Another part is having access to an exceptionally large volume of historical cases. The associated preauthorization forms can be found here. Please click here to register for an account. %%EOF All Rights Reserved. Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. You're being redirected to the CMS search site. we will be implementing changes to evicore.com in the near future. Prior authorization lookup tool. 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. reCAPTCHA is not valid; Please try again! Thank you for using eviCores website today! IMPORTANT: In the coming days, we will be migrating systems for our Highmark recently launched the Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. Should I reschedule? Please click here to register for an account. The site may also contain non-Medicare related information. Continue to Authorization Lookup Login Log In Forgot User ID? Copyright 2022 eviCore healthcare. It speaks to the rapidly evolving healthcare industry, especially the increasing role of prior authorization and how providers can more effectively navigate it. Well before the pandemic, consumers were leaning towards home healthcare versus facility based care when appropriate for a number of reasons. Eligibility Verification Providers should verify member eligibility prior to requesting/providing services. What services are managed through the Musculoskeletal Therapies Program? To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers CHCP - Resources - Precertification - Cigna Todays Auth the Cuff podcast is talking really high-tech: artificial intelligence, natural language processing, statistical modeling, oh my! Forgot Password? Click herefor the MFA registration & setup guide. How does eviCore interact with radiology patients? 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). Moving forward, please visit CoverMyMeds or via SureScripts in your EHR to learn more and submit all new PA requests electronically. wont be able to apply to eviCore openings. Registration, user access/ account assistance, portal navigation, error message understanding. Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST.