FLASH: eviCore Enhancement Resource Training and Prior Authorization Updates

Don’t miss out on our online training sessions!

As a physician-led organization, we take our responsibility to the providers in our communities seriously. Our Provider Relations teams are always here for you, and they’re constantly working hard to find new ways to make your job easier. With this goal in mind, we’re excited to announce our refreshed eviCore training sessions. These are built to give you valuable information and resources to make working with eviCore easier, faster and more collaborative.

Anyone who’s responsible for submitting prior authorization requests for our members should register for one of the following online training sessions:

  Day   Date Time (CT) Time (ET)

   Tuesday   10/5/2021 9 a.m.   10 a.m.

   Thursday 10/7/2021 2 p.m.   3 p.m.

   Wednesday  10/13/2021   12 p.m. 1 p.m.

   Friday   10/15/2021   3 p.m.   4 p.m.

How to Register:

• Once you’ve picked a session, go to this webpage.
• In the “Upcoming” tab, find the date and time of the session you want to attend. All of the training sessions are named “Health Alliance/FCC Enhancement/Resource Training.”
• Choose Register.
• Enter your registration information.

After you’ve registered, you’ll get an email that includes:

• The toll-free phone number and pass code you’ll need for the session’s audio.
• A link to the online session.
• The session password.

Save this registration email to access your session, and don’t forget to mark your calendar to make sure you’ll remember to attend.

*Please note that under the Webex webpage’s “Set Up” tab on the left, you’ll need to change your Web Page Preferences to Central Daylight Time and hit “Save.”

Background:

We understand that the process of prior authorization can be frustrating and that challenges can arise. Please know that we’re listening to you to understand your concerns, make the correct changes and implement ongoing improvement. A few years ago, we revised our approach on some prior authorization services and partnered with eviCore, a national specialty benefit management company that focuses on managing quality and use for better outcomes for our patients and providers. eviCore has managed some prior authorization services for our Commercial and Medicare lines of business to help us meet the needs of our expanding complex member populations.

The challenges of the past year shifted all focus to the operational needs of caring for our communities. And while supporting the pandemic remains critical, it’s also important we don’t lose sight of strategic initiatives that collectively move us forward. To make sure the work we focus on truly sets us up for where we intend to go, we hope the refreshed eviCore training sessions will give you resources and remove roadblocks – as we continue to be available to answer your questions.

We can’t keep improving without your input. These sessions will be led by both our own Provider Relations team members and specialists from eviCore – so it’s the perfect opportunity to get answers to all your questions. We encourage you to let us know what’s on your mind.

We look forward to hearing from you at these sessions. We care deeply about you, your staff and the care you give all our members. We’re excited to continue our important work together.

Health Alliance Prior Authorization Updates

The following procedure codes will require prior authorization through eviCore starting November 1, 2021.

• G0327 Colorectal cancer screening; blood-based biomarker
• 22510 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic
• 22511 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral
• 0331T Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment;
• 0332T Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment; with tomographic SPECT
• J9348 Naxitamab-gqgk
• Q5123 Riabni, 10 mg
• C9076 Lisocabtagene maraleucel
• C9080 Melphalan Flufenamide
• J9037 Injection, belantamab mafodontin-blmf, 0.5 mg
• J9198 Injection, gemcitabine hydrochloride, (infugem), 100 mg

Additionally, the following new procedure codes released by the AMA that are effective October 1, 2021 will require authorization through eviCore.

• 0258U Autoimmune (psoriasis), mRNA, next-generation sequencing, gene expression profiling of 50-100 genes, skin-surface collection using adhesive patch, algorithm reported as likelihood of response to psoriasis biologics
• 0260U Rare diseases (constitutional/heritable disorders), identification of copy number variations, inversions, insertions, translocations, and other structural variants by optical genome mapping
• 0262U Oncology (solid tumor), gene expression profiling by real-time RT-PCR of 7 gene pathways (ER, AR, PI3K, MAPK, HH, TGFB, Notch), formalin-fixed paraffin-embedded (FFPE), algorithm reported as gene pathway activity score
• 0264U Rare diseases (constitutional/heritable disorders), identification of copy number variations, inversions, insertions, translocations, and other structural variants by optical genome mapping
• 0265U Rare constitutional and other heritable disorders, whole genome and mitochondrial DNA sequence analysis, blood, frozen and formalin-fixed paraffin-embedded (FFPE) tissue, saliva, buccal swabs or cell lines, identification of single nucleotide and copy number variants
• 0266U Unexplained constitutional or other heritable disorders or syndromes, tissue-specific gene expression by whole-transcriptome and next-generation sequencing, blood, formalin-fixed paraffin-embedded (FFPE) tissue or fresh frozen tissue, reported as presence or absence of splicing or expression changes
• 0267U Rare constitutional and other heritable disorders, identification of copy number variations, inversions, insertions, translocations, and other structural variants by optical genome mapping and whole genome sequencing
• 0268U Hematology (atypical hemolytic uremic syndrome [aHUS]), genomic sequence analysis of 15 genes, blood, buccal swab, or amniotic fluid
• 0269U Hematology (autosomal dominant congenital thrombocytopenia), genomic sequence analysis of 14 genes, blood, buccal swab, or amniotic fluid
• 0270U Hematology (congenital coagulation disorders), genomic sequence analysis of 20 genes, blood, buccal swab, or amniotic fluid
• 0271U Hematology (congenital neutropenia), genomic sequence analysis of 23 genes, blood, buccal swab, or amniotic fluid
• 0272U Hematology (genetic bleeding disorders), genomic sequence analysis of 51 genes, blood, buccal swab, or amniotic fluid, comprehensive
• 0273U Hematology (genetic hyperfibrinolysis, delayed bleeding), genomic sequence analysis of 8 genes (F13A1, F13B, FGA, FGB, FGG, SERPINA1, SERPINE1, SERPINF2, PLAU), blood, buccal swab, or amniotic fluid
• 0274U Hematology (genetic platelet disorders), genomic sequence analysis of 43 genes, blood, buccal swab, or amniotic fluid
• 0276U Hematology (inherited thrombocytopenia), genomic sequence analysis of 23 genes, blood, buccal swab, or amniotic fluid
• 0277U Hematology (genetic platelet function disorder), genomic sequence analysis of 31 genes, blood, buccal swab, or amniotic fluid
• 0278U Hematology (genetic thrombosis), genomic sequence analysis of 12 genes, blood, buccal swab, or amniotic fluid
• 0282U Red blood cell antigen typing, DNA, genotyping of 12 blood group system genes to predict 44 red blood cell antigen phenotypes

If you have any questions, please contact your provider relations specialist.