If you are unable to use electronic prior authorization, you can call us at 1 (800) 882-4462 to submit a prior authorization request. PDF Subject: Sign- up for eviCore Healthcare's Training for new Prior If you have questions on a request handled by BCBSIL, contact our Medical Management department. All Rights Reserved. of authorization request(s). Prior Authorization - BCBSAZ Health Choice Download a form from the Forms & Resources section of the Evicore website and fax it to 1-888-693-3210. E-Verify and IER Right to Work. To determine which services require prior authorization (for medical necessity)** througheviCorefor BCBSTX government members, refer to: Medicaid providers Some authorization requirements vary by member contract. 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. The system can easily be made an extension of the clients existing claims workflow. . Some requests are handled by BCBSIL; others are handled by utilization management vendors. Find Contact Information; Podcasts; GO TO PROVIDER'S HUB. Watch this weeks episode of Auth the Cuff to learn more! E-Verify and IER Right to Work. Bluffton, SC 29910 Thank you for using eviCores website today! (This information should not be relied on as authorization for health care services and is not a guarantee of payment.). Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). 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. For many services, we manage the precertification process directly. Prior authorization (sometimes called preauthorization or pre-certification) is apre-service utilization management review. How will prior authorization determinations be communicated? Ethics & Compliance | The online portal is designed to facilitate the processing ofauthorizationrequests in a timely, efficient manner. endobj Copyright 2022 eviCore healthcare. While very useful when used appropriately, these studies have established some new guidelines to follow around this important test. For more information about prior authorization, please review Mercy Care's Provider Manuals located under the Provider Information tab on our website. ** Exception: Diabetic shoes and inserts are handled by Northwood, Inc . Review claim status and request claim adjustments. wont be able to apply to eviCore openings. Create an Account. Terms of Use | In general, there arethreestepsprovidersshould follow. Call Center: eviCore's is available from 7 a.m. to 7 p.m. 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. Reminding and guiding patients to get the care they need. . 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). Prior authorization of a service is not a guarantee of payment of benefits. endstream The site may also contain non-Medicare related information. Member Rights Policy | 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. Terms of Use | Prior authorization is required by eviCore healthcare for services performed for adult Provider Support | eviCore So how do we continue to think about best practices for telehealth? For prior authorization requests handled by BCBSIL: There are two ways to initiate your request. Please check directly with your health plan for specific requirements or contact eviCores Customer Service at (800) 918-8924. Contact Us - Health Care Providers - Aetna For more specific contact information, choose the statement below that best represents you. The table will help you determine if you can use the approved prior authorization, modify the original or request a new one. <> Annual Utilization Statistics | Manage practice information, access staff training and complete attestation requirements. Preauthorization | Blue Cross & Blue Shield of Rhode Island The site may also contain non-Medicare related information. Copyright 2022 eviCore healthcare. Beginning Friday, December 18th at 5:00pm EST, you PDF 1-888-693-3210 http://www.medsolutions.com/implementation/abhil - Aetna Contact Us | Office Locations | eviCore Providers and/or staff can request prior authorization and make revisions to existing cases by calling 1-866-496-6200. GHI Medicare non-City of New York. PNS contact tool. What additional tools are available as add-on programs to the Radiology solution? Thank you for using eviCores website today! All Requests: Utilize Authorization Inquiry function in NaviNet. 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? Examples of services that may require authorization include the following. 888-482-8057 Mon.-Fri., 8am - 11pm ET Sat., 8am - 3pm ET. What services are managed through the Musculoskeletal Therapies Program? To view this file, you may need to install a PDF reader program. Use your practice management system or vendor: Health Care Request and Response (ANSI 278) - Contact your Electronic Data Interchange (EDI) or Practice Management System vendor. eviCores innovative SmartChoice program serves as a patient-outreach service that educateshealth plan members on available options for their advanced imaging procedure locations. What is included in the Radiation Oncology program? You are leaving this website/app (site). we will be implementing changes to evicore.com in the near future. For commercialprior authorization requests handled by AIM Specialty Health(AIM): Commercial non-HMO prior authorization requests can be submitted to AIM intwo ways. You can verify benefits and request prior authorization at Availity.com or by phone at 1-888-693-3211 1-888-693-3211. 1-800-972-8382. eviCore will communicate the determination utilizing the following methods: 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". 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). Preauthorization Lists | EmblemHealth eviCore positions. 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. Were on a quest to improve the experience of administrators, clinicians, and patients who work with us. eviCore intelliPath . How does eviCore interact with radiology patients? reCAPTCHA is not valid; Please try again! Prior Authorization | Blue Cross and Blue Shield of Illinois - BCBSIL All references to Highmark in this document are references to the Highmark company that is providing the members health benefits or health benefit administration. Effective 10/13/2017 - 12/31/2020. An eviCore representative will review the information submitted to determine the next level of review for this request. Authorizations for HDHP, Standard and High Option members Report Fraud & Abuse | Providers | Getting Started | Starting A New Prior Authorization - eviCore
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