All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. Moving forward, please visit CoverMyMeds or via SureScripts in your EHR to learn more and submit all new PA requests electronically. stream Medical Oncology: Call: 1 (866) 668-9250 Fax: 1 (800) 540-2406. For precertification, go online to eviCore.com or use the contact information below. Member Rights Policy | Prime Therapeutics LLC (Prime) is a pharmacy benefit management company. Second, when requests reach a final status, the patient receives a letter indicating whether the request has been approved or denied. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. Behavioral health. The process for starting a new prior authorization depends on the health plan and solution that you are submitting the new prior authorization for. Description. eviCore positions. What digital resources can I access to find out more information? What is included in the Specialty Drug solution? 1-888-MDAETNA (1-888-632-3862) (TTY: 711) for all other plans. 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). Outpatient: 1-844-442-8012. Clinical guidelines are becoming increasingly necessary to get proper testing, but not all guidelines are created equal. You may also go directly to eviCore's self-service web portal at www.evicore.com. *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * Some requests are handled by BCBSIL; others are handled by utilization management vendors. 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). 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, PPO members You don't need to worry about referrals. endstream endobj 540 0 obj <. GEHA, like other federal medical plans, requires providers to obtain authorization before some services and procedures are performed. For inpatient hospital stays, your doctor will get prior authorization from HAP. Prescription drug prior authorization 24 hours a day, 7 days a week: 1-888-678-7015 Fax: 1-888-671-5285: . Terms of Use | Electronic Data Interchange (EDI) Email: EDI@premera.com its a guideline to help us practice medicine better, and to keep safety in mind for our patients by not over utilizing explains Dr. Robert Good, VP & Associate Chief Medical Officer for Carle Health, on how eviCores solutions have made a difference for their patients in the newest Auth the Cuff podcast. 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. Member Rights Policy | My procedure is scheduled soon and I havent heard if my case is approved or not. Medical knowledge is doubling faster than ever, as are advances on insights to access and treatment options for medical oncology. . With a PPO plan, you have the flexibility to seek care from doctors in and out of the network. Copyright 2022 eviCore healthcare. If the provider or member doesnt get prior authorization for out-of-network services, the claim may be denied. Helpful Resources: Authorization Grids As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Were still hiring for other 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. Step 2If prior authorization is required, have the following information ready: Step 3 Submit Your Prior Authorization Request. Health Plans. As a valued user of our website, we'd appreciate your feedback to help us improve your website experience. The Member Customer Care Center is open Monday-Friday, 8 am to 6 pm (ET). 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. Q4: How can eviCore make it easier for you to use this website? 400 Buckwalter Place Blvd. Terms of Use | 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. 888-482-8057 Mon.-Fri., 8am - 11pm ET Sat., 8am - 3pm ET. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. Refer to the Procedures that require authorization by eviCore healthcaredocument for more details. eviCore currently maintains a nationwide advanced imaging network, featuring contracts with providers of imaging services in specific/predetermined locationsand as well as freestanding facilities. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors. ** Prior authorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. \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). Information for Blue Cross and Blue Shield of Illinois (BCBSIL) members is found onour member site. Ethics & Compliance | External link You are leaving this website/app (site). In addition, some sites may require you to agree to their terms of use and privacy policy. Copyright 2022 eviCore healthcare. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. If you have any questions, call the number on the member's ID card. Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status While very useful when used appropriately, these studies have established some new guidelines to follow around this important test. Annual Utilization Statistics | You will receive a letter in the mail and your physician will receive a letter via fax communicating this information. Where are Musculoskeletal Program guidelines and how are they accessed? You might find that the answer is simpler than you think! Please be reminded, effective June 1, 2023, AmeriHealth Caritas Florida will require prior authorization from eviCore Healthcare for the covered health care services listed below: Report Fraud & Abuse | <>>>/BBox[ 0 0 576 201.59] /Matrix[ 0.125 0 0 0.35716 0 0] /Filter/FlateDecode/Length 7100>> Tune into our new Auth the Cuff podcast episode with guest Dr. David-Park, Sr. Medical Director PAC/DME, for a great conversation on over utilization, a real-life patient example, and more. eviCores innovative SmartChoice program serves as a patient-outreach service that educateshealth plan members on available options for their advanced imaging procedure locations. Participating providers can find more precertification phone numbers in Participating provider precertification list for Aetna (PDF). What is the fastest way to do this? Create an Account. hbbd```b`` {dd"Xdw&e7eu"j`RH2f@d\B;IH~ eviCore healthcare (eviCore) Obtain benefit preauthorization for certain care categories. Contact your designated Independence Provider Network Services (PNS) team contact. What services are managed through the Musculoskeletal Pain Management Program? Our newly redesigned provider solutions help reduce the complexities and costs involved in securing prior authorization(PA) for medical procedures and tests. eviCore intelliPath . So how do we continue to think about best practices for telehealth? 3 0 obj Highmark Blue Cross Blue Shield Delaware serves the state of Delaware. The provider is responsible for verification of member eligibility and covered benefits. Fax the request form to 888.647.6152. Services requiring prior authorization through eviCore are outlined below. 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. Watch this weeks episode of Auth the Cuff to learn more! BCBSIL contracts with Prime to provide pharmacy benefit management and other related services. As a valued user of our website, wed appreciate your feedback to help us improve your website experience. "eviCore has over 1,100 doctors, therapists and nurses from a variety of specialties. The procedure codes contained in the lists below usually require authorization (based on the members benefit plan/eligibility). x]$9n7P&zK_0wv/"}Rla@hT_RIQD*;R{|Gvg|\~I%_)u. eviCore made it easy to complete my primary task online. Apr 06, 2023. reCAPTCHA is not valid; Please try again! How do I know when my test has been authorized? Prior authorization is required by eviCore healthcare for services performed for adult endobj Certain outpatient procedures, services, supplies. Introducing eviCores new podcast Auth the Cuff! 1-888-693-3211 (TTY: 711). E-Verify and IER Right to Work. 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. We recognize that providers today navigate a complicated healthcare system while trying to make the best medical decisions for their patients. For many services, we manage the precertification process directly. Were still hiring for other How will my doctor know where I am going? Clinical Resourcespage on theBCBSTX Medicaidwebsite. If you are a Highmark network provider and have not signed up for NaviNet, learn how to do sohere. If urgent (after-hours) call 866-322-6287 , from 9 p.m. to 9 a.m., Monday through Friday. Highmark requires authorization of certain services, procedures, and/or Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) prior to performing the procedure or service. 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. Care Management Programs stream Report Fraud & Abuse | To viewrequirements summaries andprocedure code lists, refer to theSupport Materials (Commercial)andSupport Materials (Government Programs)pages. 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, 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). How will prior authorization determinations be communicated? endobj All Requests: Utilize Authorization Inquiry function in NaviNet. One option is Adobe Reader which has a built-in reader. This is not an all-inclusive list. 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, 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. Register Now The incredibly popular & eloquent nuclear stress test has been the subject of some recent studies on frequency. 539 0 obj <> endobj 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. For government programs prior authorization requests handled by eviCore healthcare (eviCore): Annual Utilization Statistics | wont be able to apply to eviCore openings. eviCore made it easy to complete my primary task online. IMPORTANT: In the coming days, we will be migrating systems for our This new site may be offered by a vendor or an independent third party. Some authorization requirements vary by member contract. Prior authorization is required by Carelon Medical Benefits Management (formerly AIM . 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). hb```|7@($qFqr&kX Q8rC%xd]ZG{5LA[K;:]*${;fR4kE[zGV@EFH;!Az. Find Contact Information; Podcasts; GO TO PROVIDER'S HUB. If you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request. Note: Most out-of-network services require utilization management review. 410 N. 44th Street, Suite 900. Q1: Overall, how satisfied are you with eviCores website? Frequently asked questions about requesting authorization from eviCore healthcare Continue to Authorization Lookup Login Log In Forgot User ID? of authorization request(s). Thank you for using eviCores website today! Thank you for using eviCores website today! Meet Dr. Scarborough, Chief of Radiology & SVP of Medical Affairs. Please join us in reflecting back on the best moments from Auth the Cuff in 2020. This new site may be offered by a vendor or an independent third party. This podcast was created with the providers in mind. Benefits > CHS Group Information" or call the prior authorization phone number on back of the member's ID card. Review claim status and request claim adjustments. To request any additional assistance in accessing the guidelines, . Thank you for using eviCores website today! Fax (24-hour) at 866-809-1370 . Copyright 2022 eviCore healthcare. services by chiropractors. Please use the BCBSAZ MA prior authorization fax form or the eviCore online request tool, available on the secure MA . 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 is included in the Medical Oncology program? Why didn't you call me the last time I had a procedure? Providers and/or staff can request prior authorization and make revisions to existing cases by calling 1-866-496-6200. In general, there arethreestepsprovidersshould follow. 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. The system can easily be made an extension of the clients existing claims workflow. To view this file, you may need to install a PDF reader program. What additional tools are available as add-on programs to the Cardiovascular solution? * 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. Forgot Password? Annual Utilization Statistics | %PDF-1.5 *, Q2: Choose the primary task you came to the website to complete:*, Q3: Please rate the following statement: * By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices. Our goal is to provide high-quality, cost-effective sleep management services to customers who are covered under benefit plans that include precertification of outpatient procedures. 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. Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Additional information on authorizations can be found in Chapter 5 (Care & Quality Management) of the Highmark Provider Manual. Terms of Use | To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers 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. 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. EmblemHealth Preauthorization List. Please retain the confirmation email. View fee schedules, policies, and guidelines. First, our innovative SmartChoiceprogram serves as a patient-outreach service to educate health plan members on available options for their diagnostic imaging procedure locations. 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. If you need preauthorization, contact eviCore in one of three ways: Get immediate approval by submitting your request at www.evicore.com. eviCore positions. 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. eviCore positions. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 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