This information is intended to serve as a reference summary that outlines where information about Highmarks authorization requirements can be found. And its provided as a free service for eviCore-managed case volume. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Copyright 2022 eviCore healthcare. open positions so continue your job search at Cigna.com/careers. Hospital and Outpatient Services. Member Rights Policy | Information for Blue Cross and Blue Shield of Illinois (BCBSIL) members is found onour member site. Refer to the March 30, 2023, provider notice (PDF) for more information and to register for training based on your physicians specialty. 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. External link You are leaving this website/app (site). Listen to the new Auth the Cuff podcast for more information. This new site may be offered by a vendor or an independent third party. PDF Prior Authorization Requests - Quick Guide - AZBlue Manage practice information, access staff training and complete attestation requirements. 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. 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. 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. Authorizations for HDHP, Standard and High Option members Radiation Therapy: Call: 1 (866) 686-4452 . Specialized therapies such as chiropractic, acupuncture, and physical therapy are cost effective, and can provide improved outcomes for chronic pain patients. The procedure codes contained in the lists below usually require authorization (based on the members benefit plan/eligibility). Always check eligibility and benefits first,via theAvailityEssentialsor your preferred web vendor, prior to rendering care and services. 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. Participating providers can find more precertification phone numbers in Participating provider precertification list for Aetna (PDF). Please join us in reflecting back on the best moments from Auth the Cuff in 2020. Prior Authorization and Notification | UHCprovider.com Why is eviCore providing intelliPath ePA free of charge for eviCore-managed lives? While very useful when used appropriately, these studies have established some new guidelines to follow around this important test. 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). Some procedures may also receive instant approval. 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 Forgot Password? Refer to theeviCore Webexpage to register and the select the menu bar symbol located on the left-side of the webpage and select "Webex Training". Q1: Overall, how satisfied are you with eviCores website? The reality is, most providers weren't initially trained to deliver virtual care. Who to Contact for Preauthorization | EmblemHealth You can also see eviCore healthcare's criteria and get request forms at . Member Rights Policy | Provider Contacts | Provider | Premera Blue Cross Please click here to register for an account. Please check directly with your health plan for specific requirements or contact eviCores Customer Service at (800) 918-8924. Please click here to register for an account. Please click here to register for an account. eviCore positions. To contact Customer Care, please call the phone number on the back of your Member ID Card. If urgent (after-hours) call 866-322-6287 , from 9 p.m. to 9 a.m., Monday through Friday. The "Live Sessions" page will display. How do I know when my test has been authorized? Q1: Overall, how satisfied are you with eviCores website? Effective dates are subject to change. Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. eviCores innovative SmartChoice program serves as a patient-outreach service that educateshealth plan members on available options for their advanced imaging procedure locations. 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. 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. You will receive a letter in the mail and your physician will receive a letter via fax communicating this information. Prior authorization of a service is not a guarantee of payment of benefits. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, CAR-T Cell Therapy & Medical Oncology Disparities, Crunching the Numbers! You'll find more information on authorizations in the GEHA plan brochure. Or . 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. Examples of services that may require authorization include the following. 3 0 obj Contact Us | Blue Cross and Blue Shield of Illinois - BCBSIL Eligibility and benefits can be verified by accessing NaviNet or by calling the number on the back of the members identification card. reCAPTCHA is not valid; Please try again! E-Verify and IER Right to Work. Sign in Learn more about electronic authorization Pre-authorization lists Commercial Frequently asked questions about requesting authorization from eviCore healthcare Federal Employee Program (FEP ) Verify eligibility and benefits and/or check claim status for FEP members. Moving forward, please visit CoverMyMeds or via SureScripts in your EHR to learn more and submit all new PA requests electronically. 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. If you do not remember your password, please click "Retrieve Password" below. If you have questions, call eviCore healthcare at . Highmark will provide written notice when codes are added to the list; deletions are announced via online publication. 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, endstream endobj startxref In practice, utilization management plays a large role in patient safety and empowerment. The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. Login | Providers | Excellus BlueCross BlueShield All web users may now protect their portal accounts with an additional layer of security, including e-mail & SMS. Subject: Sign- up for eviCore Healthcare's Training for new Prior Authorization requirements! What can chiropractic services do for my lower back pain? Step 1 Confirm if Prior Authorization is Required. The table will help you determine if you can use the approved prior authorization, modify the original or request a new one. BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. Create an Account. Were still hiring for other A prior authorization isnota guarantee of benefits or payment. Create an Account. PDF Requesting Authorization from eviCore healthcare - FAQ - BCBSM Where are Musculoskeletal Program guidelines and how are they accessed? <>>> How does eviCore interact with Post-Acute Care patients? In addition, some sites may require you to agree to their terms of use and privacy policy. It indicates which codes are handled by a vendor. 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. What is included in the Cardiovascular solution? Request Prior Authorization and Check Status Online via Provider Access Step 2If prior authorization is required, have the following information ready: Step 3 Submit Your Prior Authorization Request. -fUk23Hl\`U x@H2X"7"*,U D Please click here to register for an account. eviCore intelliPath streamlines operations within a single easy-to-use application that integrates with major EHRs. Preauthorization Lists New Empire Precertification Requ . 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, To view this file, you may need to install a PDF reader program. Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. 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.
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