Update: New Benefit Preauthorization Requirements through eviCore
(Updated Sept. 23, 2016*)
*As of Sept. 26, 2016, providers will be able to contact eviCore to request preauthorization for dates of service on and after Oct. 3, 2016, for outpatient molecular and genomic testing and outpatient radiation therapy. You can reach eviCore at evicore.com or toll-free at 855-252-1117. Access to eviCore healthcare’s preauthorization call center is available from 7 a.m. to 7 p.m. Monday through Friday.
Effective October 3, 2016, Blue Cross and Blue Shield of Oklahoma (BCBSOK) has contracted with eviCore healthcare (eviCore)*, an independent specialty medical benefits management company, to provide preauthorization services for new requirements outlined below.
eviCore will manage preauthorization for molecular and genomic tests and radiation therapy for dates of service beginning October 3, 2016. Services performed without preauthorization that do not meet medical necessity criteria may be denied for payment, and the rendering provider may not seek reimbursement from members. For any service not approved for payment, BCBSOK will offer all appropriate rights for re-review or appeal.
You will continue to use iExchange® for all other services that require a referral and/or preauthorization.
Both BCBSOK and eviCore will be providing additional information, including training opportunities, in the coming months on the Provider website at bcbsok.com/provider and in Blue Review. You may also contact your Provider Network Representative for more information.
*eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for Blue Cross and Blue Shield of Oklahoma.