April 15, 2019
Blue Cross and Blue Shield of Oklahoma (BCBSOK) contracts with eviCore healthcare (eviCore), an independent specialty medical benefits management company, for outpatient specialty preauthorizations.
After you use Availity® or your preferred vendor and determine the service for your member requires preauthorization through eviCore, you can save a lot of time by submitting preauthorization requests through eviCore’s provider portal. eviCore recently made several improvements to make requests even easier.
Submitting a request through the portal helps make sure the request is submitted correctly and includes the needed information, which will help smooth the approval process. Using the eviCore provider portal to submit requests for preauthorization will also allow you to:
- Review clinical criteria — review guidelines to see what’s required, prior to submitting your request
- Save time — online benefit preauthorization requests are three times faster than phone requests
- Access requests 24/7 — submit requests and check their progress when it is convenient
- Stop and start as needed — save your benefit preauthorization request and return to it later, without the need to start over
- View and print results — see case numbers and approval details online
- Show you which procedure codes/diagnoses are impacted — see codes for applicable categories/members
- Upload member’s medical records — use the portal to respond quickly with clinical information necessary to support medical necessity of the service/procedure
- Schedule consultations online — set up a Clinical Consultation through the portal if you have questions.
To begin managing authorizations online, go to eviCore.com and register. Training sessions are available through the eviCore training center. For provider portal help, email firstname.lastname@example.org or call 800-646-0418 and select option 2.
Important Reminder: Always Check Eligibility and Benefits First
Benefits will vary based on the service being rendered and individual and group policy elections. It is critical to check eligibility and benefits for each patient to confirm coverage details. This step will also identify benefit preauthorization and any prenotifications that may be required. Submit online eligibility and benefits requests (electronic 270 transactions) via the Availity Provider Portal or your preferred web vendor portal.
Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.
eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSOK. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as eviCore, Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.