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FLASH: Preauthorizations for OB Ultrasounds

Starting immediately, we will no longer require preauthorizations for the first instance of standard ultrasound, greater than 14 weeks gestation (76805, or 76810 if there are multiple fetuses) or the first instance of nuchal translucency ultrasound (76813, or 76814 if there are multiple fetuses).
 
If one of our members needs another 76805/76810 or 76813/76814 within a 10-month period, you’ll need to submit your preauthorization through eviCore in order for the claim to process correctly.
 
If you have any questions about this change, contact your provider relations specialist.

Preauthorization Process Update for OB/Ultrasound Requests

Currently, if your patient requires multiple OB/ultrasounds, you’re required to start individual case requests for each procedure. Starting June 1, you’ll be able to include multiple OB/ultrasounds on the same case request through eviCore.

The 2017 OB guidelines support a growth ultrasound every 3 to 6 weeks for most high-risk conditions and every 2 to 4 weeks in a few high-risk scenarios, such as in a fetal growth restriction, twins, and oligohydramnios. Multiple units of these procedure codes can be considered if certain clinical criteria are met (see the guidelines for those criteria specifics):  76815, 76816, 76817, 76818, 76819, 76820, and 76821.

In the Clinical Certification section of eviCore’s case request, you’ll now be able to add frequency and multiple dates of service details, which lets you include all OB/ultrasounds on the same request under one case/authorization number.

Clinical Certification

To start these cases online, use eviCore under the Request Preauthorization tab of Your Health Alliance for providers. If you have questions about this new process, contact eviCore’s Client Provider Operations department at ClientServices@evicore.com.

And use the eviCore Resources link in the Forms & Resources section to connect to more eviCore resources.

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