Portal Login Insights Blog eviCore Colorectal Screening Program Do you offer a mandatory prior authorization program for all sleep studies? Provider costs are reduced and decisions are communicated in real time, reducing delays. 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 Fax (24-hour) at 866-809-1370 . Health Plans. 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. Step 1 Confirm if Prior Authorization is Required. <> The eviCore intelliPath. : 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. This new site may be offered by a vendor or an independent third party. 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 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. Dont I have to go to a hospital for my procedure? How does eviCore interact with radiology patients? reCAPTCHA is not valid; Please try again! 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. \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). In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. You are leaving this website/app (site). Multi-Factor Authentication (MFA) is now live on eviCores web portal! *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * wont be able to apply to eviCore openings. 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. Inpatient Planned Requests: Call Highmark Clinical Services; Press 2 for authorization requirements/ status. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Phone Number 1.800.646.0418 x20136 Email portal.support@evicore.com Affiliations Stay Updated With Our Provider Newsletter Your email address Website Feedback Thank you for using eviCore's website today! How does a computer make healthcare decisions? Emergency services are an exception. Please click here to register for an account. Please click here to register for an account. E-Verify and IER Right to Work. What additional tools are available as add-on programs to the Cardiovascular solution? If you are unable to use NaviNet, you may also fax your authorization requests to one of the following departments. Check eligibility and benefits for members. Hospital and Outpatient Services. Where are Musculoskeletal Program guidelines and how are they accessed? . PROVIDERS AREA. 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. The table will help you determine if you can use the approved prior authorization, modify the original or request a new one. Call 1-800-TALK-MVP (1-800-825-5687) to speak with an MVP representative. 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. wont be able to apply to eviCore openings. %PDF-1.6 % eviCore positions. Q4: How can eviCore make it easier for you to use this website? Terms of Use | 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. Forgot Password? Visit www.evicore.com Call 800.533.1206 Monday - Friday: 7:00 a.m. to 7:00 p.m. Helpful Resources: Authorization Grids Hospitals should contact CareAllies at (800) 227-9360 to obtain prior authorization. Beginning Friday, December 18th at 5:00pm EST, you Copyright 2022 eviCore healthcare. 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. The authorization is typically obtained by the ordering provider. Continue to Authorization Lookup Login Log In Forgot User ID? stream Part of it involves making sure the computer speaks the same language as the medical records. Privacy Policy | Annual Utilization Statistics | 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. eviCore made it easy to complete my primary task online. Effective dates are subject to change. reCAPTCHA is not valid; Please try again! Highmark adheres to the Centers for Medicare and Medicaid Services (CMS) coverage determinations for Medicare Advantage (MA) membership. Or you can call Provider Services at . Check eligibility and benefits for members. Highmark recently launched the Auth Automation Hub utilization management tool that allows offices to submit, update, and inquire on authorization requests. How does a provider check the prior authorization status for a member? There is a notion of utilization management being solely focused on cost savings. Blue Cross and Blue Shield of Texas (BCBSTX) has contracted witheviCore healthcare (eviCore)*to provide certain utilization management prior authorization services for our government programs. EmblemHealth Preauthorization List. To viewrequirements summaries andprocedure code lists, refer to theSupport Materials (Commercial)andSupport Materials (Government Programs)pages. The reality is, most providers weren't initially trained to deliver virtual care. $4d? vI One option is Adobe Reader which has a built-in reader. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. What additional tools are available as add-on programs to the Radiology solution? My procedure is scheduled soon and I havent heard if my case is approved or not. 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. Trials, Treatments, and Oncology Breakthroughs, Check Status of Existing Prior Authorization. Member Rights Policy | Were still hiring for other All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Prior authorization fax: 800-267-8328 Behavioral health prior authorization fax: 877-840-5581. 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. Member Rights Policy | Please click here to register for an account. For government programs prior authorization requests handled by eviCore healthcare (eviCore): 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. PPO members You don't need to worry about referrals. 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. we will be implementing changes to evicore.com in the near future. 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. Use theAvailityProvider Portalor your preferred vendor to check eligibility and benefits before rendering services. . Copyright 2022 eviCore healthcare. You can fax your authorization request to 1-800-217-9345. of authorization request(s). Report concerns to the BCBSIL Special Investigations Department (SID) Fraud website 1 . *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * 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. For quick reference, see the GEHA member's ID card. Please retain the confirmation email. Privacy Policy | eviCore intelliPath streamlines operations within a single easy-to-use application that integrates with major EHRs. IMPORTANT: In the coming days, we will be migrating systems for our And its provided as a free service for eviCore-managed case volume. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. You will be contacted by an eviCore representative within 5 business days. Please click here to register for an account. eviCore made it easy to complete my primary task online. Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. eviCore intelliPath reflects eviCores commitment to modernize prior authorization and remove barriers to evidence-based care. 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. What is included in eviCores Comprehensive Oncology program? Annual Utilization Statistics | BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. information about accessing the eviCore portal. eviCores provider experience solution offers providers ongoing touchpoints that include a team dedicated to on-site visits; professional surveys; and the rigorous tracking and receiving of feedback from both providers and our clients. If you have questions, call eviCore healthcare at . What do I tell my patient when their case is denied? What services are managed through the Musculoskeletal Surgical Program? E-Verify and IER Right to Work. 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. Report Fraud & Abuse | Learn more about the life-interrupting issue of back pain, and the long-term benefits of saving surgery for a last resort. Subject: Sign- up for eviCore Healthcare's Training for new Prior Authorization requirements! Telephone:For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. What types of cardiovascular procedures require prior authorization? -fUk23Hl\`U x@H2X"7"*,U D 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. Prior Authorization Automation. 400 Buckwalter Place Blvd. reCAPTCHA is not valid; Please try again! The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. Bonus! 2 0 obj Ethics & Compliance | Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. eviCoreis an independent company that provides specialty medical benefits management for BCBSTX. 3 0 obj Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) prior to performing the procedure or service. Sometimes, a plan may require the member to request prior authorization for services. Submit requests via fax to 1-888-693-3210 Monday through Friday between 8 a.m. and 9 p.m. EST.
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