eviCore Healthcare Radiology Program FAQs
This document provides essential information and frequently asked questions about the eviCore healthcare Radiology Program. It covers the services managed by eviCore healthcare for BCBS members. Whether you are a physician or a member, this guide will help you understand the authorizations needed for outpatient radiology services.
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How do I fill this out?
To fill out this file, start by gathering all necessary member and physician information. Ensure you have the clinical notes and service details ready. Follow the detailed instructions in the subsequent sections to complete the authorization form effectively.
How to fill out the eviCore Healthcare Radiology Program FAQs?
1
Gather member's name, date of birth, plan name, and ID number.
2
Collect ordering physician's name, NPI, and TIN.
3
Include rendering facility information and service request details.
4
Prepare relevant clinical notes and documentation.
5
Submit the completed form through the specified method.
Who needs the eviCore Healthcare Radiology Program FAQs?
1
Physicians needing prior authorization for outpatient radiology services.
2
Medical staff handling patient information for BCBS members.
3
Members of BCBS Medicare and Medicaid who require imaging services.
4
Administrative personnel responsible for managing authorization requests.
5
Appeal representatives advocating for service approvals.
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What are the instructions for submitting this form?
Submit the completed form through the online portal at www.evicore.com or fax it to 866-699-8128. For mail submissions, send to: eviCore healthcare, Attn: Clinical Appeal Dept, 400 Buckwalter Place Blvd, Bluffton, SC 29910. Always retain a copy of the submitted form for your records and follow up to ensure receipt.
What are the important dates for this form in 2024 and 2025?
Keep an eye out for important dates regarding submission and review deadlines related to authorizations throughout 2024 and 2025.
What is the purpose of this form?
The purpose of this form is to streamline the authorization process for outpatient radiology services under eviCore healthcare management. It ensures that all necessary information is gathered and submitted for review efficiently. This form helps both healthcare providers and patients navigate the approval process effectively.
Tell me about this form and its components and fields line-by-line.
- 1. Member Information: Includes fields for the member's name, date of birth, and plan details.
- 2. Physician Information: Collects data regarding the ordering physician's credentials.
- 3. Facility Information: Details about the rendering facility, including its address and identification numbers.
- 4. Service Details: Specifics about the services being requested, including procedure codes.
- 5. Clinical Notes: Important notes and medical history relevant to the authorization request.
What happens if I fail to submit this form?
Failure to submit this form may result in delays in receiving necessary authorizations for radiology services. Additionally, it could lead to a denial of services, impacting patient care.
- Delayed Care: Without proper authorization, patients may experience delays in receiving imaging services.
- Increased Denials: Incomplete submissions can lead to higher rates of denial for requested services.
- Compliance Issues: Not following submission guidelines may result in compliance issues with healthcare regulations.
How do I know when to use this form?
- 1. Pre-authorization Requests: To obtain pre-authorization for necessary imaging services.
- 2. Medicaid and Medicare Services: When BCBS members utilize Medicaid or Medicare plans for imaging.
- 3. Appeal Processes: In the event of a denial, this form is required to initiate the appeal process.
Frequently Asked Questions
What types of authorizations does eviCore manage?
eviCore manages prior authorizations for specific outpatient radiology services under BCBS plans.
How can I check my authorization status?
You can check the authorization status through the web portal at www.evicore.com or by calling 855-252-1117.
What information is required for authorization?
Essentially, you will need member information, physician details, and relevant clinical documentation to apply for authorization.
How long does it take to get an authorization decision?
eviCore aims to provide decisions within 14 calendar days upon receiving all necessary information.
What happens if my authorization request is denied?
You will receive a denial letter stating the reason for denial, along with options for reconsideration or appeal.
How long is an authorization valid?
Authorizations are valid for 45 calendar days.
Can urgent requests be expedited?
Yes, urgent requests can be handled faster by calling eviCore directly.
Is there a guarantee of payment with prior authorization?
Prior authorization does not guarantee payment; eligibility and coverage are also considered.
Who can file an appeal for a denied authorization?
An authorized representative or the member with written consent can file an appeal.
Where do I send my appeals?
Appeals can be submitted via mail, fax, or email to the eviCore Appeals Department.
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