FLASH: Temporary Changes to Therapy Preauthorizations

After many discussions with providers and partners, we’ve decided to make significant temporary changes in the rollout of our preauthorization program with eviCore. In order to provide additional time for education, communication, and collaboration around this program, we’ll be significantly reducing or eliminating the clinical assessment required for getting therapy preauthorizations.

Beginning October 23, 2017 and until further communication, eviCore will put in new pathways for requests for all covered therapeutic programs, which will reduce the information needed for preauthorizations. You should be prepared with an anticipated number of visits and units needed to deliver patient care over the next 90 days when submitting a request.

In almost all cases, after submitting a preauthorization request on eviCore, you will receive an authorization for the requested visits and units, which will be valid for the next 90 days. If needed, this can also be extended for another 30 days with an online request to eviCore. As always, regardless of authorization, we expect you will be judicious in using approved visits for visits that are medically necessary and justified by the progress of each patient.

Note: Regardless of this temporary process change, you will still need appropriate authorizations for procedures when submitting your claims for payment.

We recognize that the rollout of this program has been difficult for many providers, and that it’s been difficult to align some existing clinical and administrative procedures with the need to obtain preauthorization from eviCore. During this time, we look forward to working with eviCore and you on making a smooth transition back to a more robust preauthorization program with limited administrative burden in the near future.