We are updating this notification to reflect a change in the effective date of the eviCore implementation. Effective February 18, 2019, eviCore healthcare will administer prior authorization services for high tech radiology and pain management for Mercy Care RBHA. Services requiring authorization but performed without authorization may be denied for payment, and you may not seek reimbursement from members.
To access the list of CPT codes that require prior authorization, please click on the following link:
Services performed in conjunction with an inpatient stay, observation, or emergency room visit are not subject to authorization requirements.
In order to request an authorization from eviCore healthcare, please submit your request online, by phone or by fax to:
- Log onto the eviCore healthcare Online Web Portal.
- Call eviCore healthcare at 888-693-3211
- Fax an eviCore healthcare Request Form (available online at the eviCore healthcare Online Web Portal) to 888-693-3210
For urgent requests:
If services are required in less than 48 hours due to medically urgent conditions, please call eviCore healthcare’s toll-free number for expedited authorization reviews. Be sure to tell the representative the authorization is for medically urgent care.
eviCore healthcare recommends that ordering physicians secure authorizations and pass the authorization numbers to the rendering facilities at the time of scheduling. eviCore healthcare will communicate authorization decisions by fax to both the ordering physicians and requested facilities. Authorizations contain authorization numbers and one or more CPT codes specific to the services authorized. If the service requested is different than what is authorized, the rendering facility must contact eviCore healthcare for review and authorization prior to claim submission. If not done, this could result in claim denials.
As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our
Mercy Care website
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