Effective with dates of service June 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 June 1, 2017 may be denied for payment if you do not get prior authorization. You may not seek reimbursement from members. eviCore healthcare will be available to start taking prior authorization requests for pain management from providers on May 15, 2017 for dates of service on or after June 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. 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.
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, please contact eviCore healthcare for review and authorization prior to claim submission.
eviCore will provide online orientation sessions to providers who need additional training. 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!
QB 2668
|
