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PROVIDER NOTIFICATION
Important Information and Provider Notices
June 27, 2017
eviCore healthcare - prior authorization for pain management
Plans Affected:   Mercy Care Plan, Mercy Care Plan Long Term Care and Mercy Care Advantage
Effective with dates of service August 1, 2017, prior authorization for pain management will be administered by eviCore healthcare for Mercy Care Plan. Pain management services requiring authorization but performed without authorization on or after August 1, 2017 may be denied for payment if you do not get prior authorization. You may not seek reimbursement from members.  eviCore healthcare will start to take phone calls from providers on July 17, 2017 for dates of service on or after August 1, 2017. 

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. 
  • Log onto the eviCore healthcare Online Web Portal via the following web portal:  https://www.evicore.com/pages/providerlogin.aspx.  Utilizing the web portal is the quickest, most efficient way to initiate a request. 
  • Call eviCore healthcare at 888-693-3211. 
  • Fax an eviCore healthcare Request Form (available online at the eviCore healthcare Online Web Portal) to 844-822-3862.
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 recommend 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 request is different than what is authorized, the rendering facility must contact eviCore healthcare for review and authorization prior to claim submission. 
 
eviCore will provide online orientation sessions to providers who need additional training (see below for training schedule and instructions for registering).  The orientation session schedule, program training resources, Clinical Guidelines, CPT codes management and fax request forms are available at the following URL: https://www.evicore.com/healthplan/MCP . Please e-mail our client services department at clientservices@eviCore.com if you have questions or need more information.
 
As always, don't hesitate to contact your Provider Relations Representative with any
questions or comments. You can find this notice and all other provider notices posted on our website.
  
Thanks for all you do!

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Online Training Sessions
To attend of the online training sessions, please register in advance.  Each session is free and will last approximately one hour. 

Day                            Date                                                Time
Friday                    July 14, 2017                               3:00 p.m., Central
Monday                July 17, 2017                               11:00 a.m., Central
Tuesday                July 25, 2017                               10:00 a.m., Central
Wednesday         August 2, 2017                             4:00 p.m., Central

How to Register 
  • Once you have chosen a date and time, go to eviCore.webex.com.
  • Choose the Training Center tab at the top of the web page. 
  • Find the date and time of the session you want to attend in the Upcoming tab.  All of the training sessions will be named "Mercy Care Plan AZ Pain Management."
  • Choose Register. 
  • Enter your registration information. 

After you have registered for the online training session, you will receive an e-mail that includes:   

  • The toll-free phone number and pass code you will need for the audio portion of the session. 
  • A link to the web portion of the session. 
  • The session password. 

Please save the registration e-mail to access your online training session.  Please mark your calendar and ensure that you are able to fully participate so you can receive the necessary training to provide exceptional care to your patients. 

 

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