Reid April Newsletter

Preauthorization Updates

We will be sharing regular updates about functionality changes to our preauthorization tools – Clear Coverage, eviCore, and Health Alliance preauthorization forms.

eviCore

Finish Later and Attach Clinicals Later

• This has been updated so provider offices can choose Finish Later to come back to an authorization within 2 business days. This also allows you to attach the clinicals before submitting a preauthorization.

OB Ultrasounds

• At this time, multiple OB ultrasounds cannot be batched into one authorization request.
• Submit separate authorizations when multiple exams are requested.
• We’re working with eviCore for a solution, and we will keep you updated as changes occur.

Breast Ultrasounds

• Do not require preauthorization.

OB/GYN Codes Flipped

• From time to time, users experienced changes to CPT codes within the eviCore system. This issue has been corrected, and OB/GYN offices should no longer be seeing this problem.

Can’t Choose Rendering Provider

• As of March 13, we’ve corrected the issue that you could not choose providers, including physicians, hospitals, and imaging centers, as the rendering provider or site. (You will no longer receive the message, “not certified for this program” when you make this selection.)

Rendering Provider vs. Ordering Provider

• Rendering provider and ordering provider are the same as long as the rendering provider is not a hospital or imaging center.

Don’t Use the Enter Key on Your Keyboard

• eviCore requires you to choose select, continue, or submit on a preauthorization. If you use the Enter key on your keyboard, the preauthorization will be lost, and it will take you back to the beginning.

Clear Coverage

Call with Inpatient Home Health Discharges Preauths

• Preauthorizations for patients being discharged from an inpatient setting to home health will be handled by calling our medical management department. Use Clear Coverage for all outpatient home health preauthorizations.

Missing CPT Codes

• The missing CPT codes for home health have been updated and can now be selected.

Meet with a Coding Specialist

The risk adjustment coding consultants are continuing to request meetings with high-volume participating provider offices. These meetings are designed to share member-specific examples of coding and quality measure needs and to update providers on the latest efforts to educate on risk adjustment. Along with member specific examples, there is information on yearly risk adjustment data validation (RADV) audits, and how provider practice participation is essential in this process.

A member of the coding consultant team is willing to meet with you to discuss any coding or quality questions you may have, or to provide member-specific examples from your panel of members. If interested, contact us at CodingCounts@healthalliance.org.