Were still hiring for other Our hosts Dr. Torelli and Liz Avila are here to explain why. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Reminding and guiding patients to get the care they need. eviCoreis an independent company that provides specialty medical benefits management for BCBSTX. What is included in the Specialty Drug solution? Some requests are handled by BCBSIL; others are handled by utilization management vendors. View fee schedules, policies, and guidelines. This new site may be offered by a vendor or an independent third party. What is included in the Radiology solution? My procedure is scheduled soon and I havent heard if my case is approved or not. Bonus! Moreover, eviCore is the only company in the industry with dedicated, separately maintained pediatric guidelines. Q1: Overall, how satisfied are you with eviCores website? Why was my test, treatment, or procedures not approved? Annual Utilization Statistics | Online - The eviCore Web Portal is available 24x7. eviCore intelliPath streamlines operations within a single easy-to-use application that integrates with major EHRs. In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. Step 1 Confirm if Prior Authorization is Required. Check eligibility and benefits for members. 539 0 obj <> endobj Directory Who to Contact for Preauthorization All providers must verify member eligibility and benefits prior to rendering non-emergency services. IMPORTANT: In the coming days, we will be migrating systems for our eviCore positions. Medical knowledge is doubling faster than ever, as are advances on insights to access and treatment options for medical oncology. eviCore made it easy to complete my primary task online. Register Now Well before the pandemic, consumers were leaning towards home healthcare versus facility based care when appropriate for a number of reasons. 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. Tune into our new podcast episode with eviCore's medical oncologists Dr. McLead, Associate Medical Director, and Dr. Gaskins, Sr. Medical Director, for an informative conversation on clinical trials, disparities in medical oncology, and how eviCore is aiming to bridge the gap with the most recent evidence-based options for oncology patients. Our proprietary integrated system, Claims Studio, delivers savings through an enhanced focus on accurate claims payment. 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). Terms of Use | You might find that the answer is simpler than you think! 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, 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. How do I obtain clinical certification for radiology tests? 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). This information is intended to serve as a reference summary that outlines where information about Highmarks authorization requirements can be found. endobj Echocardiograms also just so happen to be one of the most common inappropriately ordered tests. To viewrequirements summaries andprocedure code lists, refer to theSupport Materials (Commercial)andSupport Materials (Government Programs)pages. Beginning Friday, December 18th at 5:00pm EST, you To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers Driving Directions 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. eviCore.com 1-855-252-1117. Member Rights Policy | 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, Check eligibility and benefits for members. Forgot Password? MCG Clinical Criteria- Information on Highmark's incorporation of MCG Health evidence-based clinical guidelines into Highmarks criteria of clinical decision support. Create an Account. reCAPTCHA is not valid; Please try again! Effective dates are subject to change. E-Verify and IER Right to Work. Do you offer a mandatory prior authorization program for all sleep studies? Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. Q4: How can eviCore make it easier for you to use this website? By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. Member Rights Policy | 410 N. 44th Street, Suite 900. Usually, the provider is responsible for requesting prior authorization before performing a service if the member is seeing an in-network provider. 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. Always check eligibility and benefits first,via theAvailityEssentialsor your preferred web vendor, prior to rendering care and services. Simply visit the eviCores Providers Hub page and select the health plan and solution option for your case in the training section. 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. 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. One option is Adobe Reader which has a built-in reader. Ethics & Compliance | The incredibly popular & eloquent nuclear stress test has been the subject of some recent studies on frequency. The "Live Sessions" page will display. What is included in the Medical Oncology program? What services are managed through the Musculoskeletal Surgical Program? Mailing address. In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. For more specific contact information, choose the statement below that best represents you. Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST. Frequently asked questions about requesting authorization from eviCore healthcare we will be implementing changes to evicore.com in the near future. Call 1 (800) 88CIGNA (882-4462). endobj Member Rights Policy | Each of these companies is an independent licensee of the Blue Cross Blue Shield Association. Report Fraud & Abuse | 888-482-8057 Mon.-Fri., 8am - 11pm ET Sat., 8am - 3pm ET. 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? If you do not remember your password, please click "Retrieve Password" below. 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. We recognize that providers today navigate a complicated healthcare system while trying to make the best medical decisions for their patients. 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. Ethics & Compliance | . Provider costs are reduced and decisions are communicated in real time, reducing delays. Information for Blue Cross and Blue Shield of Illinois (BCBSIL) members is found onour member site. I agree to HIPAA Disclosure Remember User ID LOGIN Don't have an account? This new site may be offered by a vendor or an independent third party. Service preapproval is based on the members benefit plan/eligibility at the time the service is reviewed/approved. 571 0 obj <>stream Report Fraud & Abuse | The list indicates which CPT codes require preauthorization based on site of service and diagnosis codes. The system can easily be made an extension of the clients existing claims workflow. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Pharmacy Prior Authorization eviCore Medical Oncology Drug List E-Verify and IER Right to Work. Most PDF readers are a free download. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime. What can physical therapy do for my lower back pain? Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status Contact Us; Search. Blue Cross, Blue Shield and the Blue Cross and Blue Shield symbols are registered marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. What is included in eviCores Comprehensive Oncology program? Medical Oncology: Call: 1 (866) 668-9250 Fax: 1 (800) 540-2406. 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. Services billed with the following revenue codes always require prior authorization: 0240-0249 All-inclusive ancillary psychiatric. Availity is a trademark of Availity, LLC., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Terms of Use | As a result, eviCore helps reduce inappropriate utilization, unnecessary radiation exposure, and invasive procedures and thereby improves patient safety. 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. 2 0 obj The instructions on how to submit a case and a link to the correct portal to use will be provided. Prior Authorization Automation. Register Now Note: Checking eligibility and benefits is key, butwe also have other resources to help you prepare. Description. See Clinical Corner for services that require Preauthorization. Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. I need to change the CPT code on my request. Or you can call Provider Services at . Tune into our new Auth the Cuff episode with eviCore's Dianne Doherty, Sr. hb```|7@($qFqr&kX Q8rC%xd]ZG{5LA[K;:]*${;fR4kE[zGV@EFH;!Az. The table will help you determine if you can use the approved prior authorization, modify the original or request a new one. Use theAvailityProvider Portalor your preferred vendor to check eligibility and benefits before rendering services. 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. eviCore healthcare (eviCore) Obtain benefit preauthorization for certain care categories. Copyright 2022Health Care Service Corporation. . open positions so continue your job search at Cigna.com/careers. For more detailed information, including specific CPT codes that requireeviCoreprior authorization, visit theeviCore implementation siteand select the BCBSTX health plan for the applicable CPT/HCPCS code lists and physician worksheets by service. Call 1-888-233-8158 from 8:00 a.m. to 9:00 p.m., Eastern, Monday through Friday. Report concerns to the BCBSIL Special Investigations Department (SID) Fraud website 1 . This new site may be offered by a vendor or an independent third party. Contact J&B at 1-888-896-6233 or . Call Utilization Management at 855-339-8127, 9 a.m to 9 pm., Monday through Friday. Lab Prior Authorization CPT Code List. 0901, 0905-0907, 0913, 0917 Behavioral health treatment services. Click herefor the MFA registration & setup guide. Copyright 2022 eviCore healthcare. stream Some procedures may also receive instant approval. Bluffton, SC 29910 Call Customer Service at 888-850-8526, 8 a.m. to 8 p.m., Monday through Sunday. If you need preauthorization, contact eviCore in one of three ways: Get immediate approval by submitting your request at www.evicore.com. Beginning Friday, December 18th at 5:00pm EST, you Additional information on authorizations can be found in Chapter 5 (Care & Quality Management) of the Highmark Provider Manual. If the provider or member doesnt get prior authorization for out-of-network services, the claim may be denied. open positions so continue your job search at Cigna.com/careers. Participating providers can find more precertification phone numbers in Participating provider precertification list for Aetna (PDF). 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). 1-800-624-0756 (TTY: 711) for HMO and Medicare Advantage benefits plans. Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia plus Washington County. In addition, some sites may require you to agree to their terms of use and privacy policy. 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. Member Rights Policy | %PDF-1.5 0 Once a prior authorization request is received and processed, the decision is communicated to the provider. Many changes will take effect \u003cstrong\u003eJuly 6, 2023\u003c/strong\u003e. Certain employer groups may require prior authorization or pre-notification through other vendors. \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). Federal Employee Program (FEP ) Verify eligibility and benefits and/or check claim status for FEP members. eviCore will communicate the determination utilizing the following methods: 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. Highmark recently launched the Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Copyright 2022 eviCore healthcare. 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. For many services, we manage the precertification process directly. Radiation Therapy: Call: 1 (866) 686-4452 . Were still hiring for other Online forms from eviCore's carriers hub MENU PROVIDERS About; Solutions. of authorization request(s). All Requests: Utilize Authorization Inquiry function in NaviNet. Finally, eviCore manages select cardiology and radiology services for dates of service prior to Oct. 1, 2018, including postservice requests. How did you get my phone number/information? GHI Medicare non-City of New York. 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. Q4: How can eviCore make it easier for you to use this website? 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 For inpatient hospital stays, your doctor will get prior authorization from HAP. eviCore interacts with radiology patients in two ways. 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. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * 6 0 obj The site may also contain non-Medicare related information. 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. From cultural moments, to utilization management, capsule endoscopy technology advancements, and more. GEHA, like other federal medical plans, requires providers to obtain authorization before some services and procedures are performed. 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. Request a Consultation with a Clinical Peer Reviewer, Check Status Of Existing Prior Authorization, Preventive Care Outreach: Partnering to Improve Health Outcomes, Lower Costs and Increase CMS Scores, Q&A: eviCores Dr. Lon Castle on Evidence-Based Lab Testings Ability to Improve Patient Outcomes & Reduce Costs, eviCores Dr. Robert Westergan on Managing Site of Care and Implants for Musculoskeletal (MSK) Conditions, Check Status of Existing Prior Authorization.
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