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eviCore healthcare (eviCore) A medical benefits management company offering solutions to help health plans and other organizations reduce costs while increasing the safety and quality of care for members.
What happens if a preauthorization or precertification is denied?
Whether a denial is based on medical necessity or benefit limitations, patients or their authorized representatives (such as their treating physicians) can appeal to health plans to reverse adverse decisions. In most cases, patients have up to 180 days from the service denial date to file an appeal.
What is the process for precertification?
Prior authorizationsometimes called preauthorization or precertificationis a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
Does Aetna use eviCore for authorization?
Aetna has released a new policy requiring physicians and other healthcare professionals to work with eviCore to pre-authorize peripheral services such as angioplasty, stenting, atherectomy, and intravascular ultrasound (IVUS), effective September 1, 2023.
Who is responsible for getting pre authorization Aetna?
Your primary care physician (PCP) will give Aetna Better Health of California information about the services that they think you need. An Aetna Better Health of California provider will review the information.
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Who We Are. eviCore is the recognized industry leader in medical benefits management, with more than 25 years of experience covering 100 million lives.
How do I contact eviCore for prior authorization?
Please contact us at (800) 918-8924 to change the CPT code on your request. You can also email our team at webcontactrequests@evicore.com. Please continue to share your feedback, suggestions, and questions about our prior authorization process by contacting us at providernewsletter@evicore.com.
Does Aetna use eviCore healthcare?
eviCore Healthcare (formerly MedSolutions) is Aetnas preferred national vendor that reviews preauthorization requests for services for Aetna members who live in and/or receive covered services in states/markets that have the Enhanced Clinical Review (ECR) Program implemented.
Related links
your prior authorization for Medicare Advantage
Mar 2, 2023 * Aetna Medicare Advantage PPO only covers services approved under Traditional. Medicare and administered by a Medicare-certified provider. If
Medical Exception/Prior Authorization/Precertification*
PLEASE CHECK ALL BOXES THAT APPLY: Do you want a drug specific prior authorization criteria form faxed to your office? Yes No (If yes, no further questions
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