eviCore Preauthorization Program
Blue Cross and Blue Shield of Montana (BCBSMT) has contracted with eviCore healthcare (eviCore)* to provide certain utilization management services for outpatient molecular and genomic testing, this in addition to the current Outpatient Radiation Therapy preauthorization managed by eviCore. eviCore is an independent company that provides specialty medical benefits management for BCBSMT.
BCBSMT requires preauthorization (for medical necessity) ** through eviCore for outpatient molecular and genomic testing and outpatient radiation therapy for the following benefit plans:
- All individual plans
- All fully insured commercial groups
- All self-insured groups
Refer to the eviCore implementation site and select the BCBSMT health plan for the applicable CPT/HCPCS code list and radiation therapy physician worksheets.
Lab Management Program
In an effort to make access to the Lab Management Program information streamlined for our clients and providers, eviCore has created a new one stop link for your Lab Resources . This will house the Lab CPT codes under management, Lab Clinical Guidelines, and any additional information that may be beneficial.
Medicare Advantage Program
Blue Cross Medicare Advantage HMOSM and Blue Cross Medicare AdvantageSM PPO effective 06/01/2017
Requires preauthorization (for medical necessity) ** through eviCore for the following codes:
- Outpatient Molecular Genetics
- Outpatient Radiation Therapy
- Physical and Occupational Therapy
- Speech Therapy
- Spine Surgery (Outpatient/Inpatient)
- Spine Lumbar Fusion (Outpatient/Inpatient)
- Interventional Pain
- Outpatient Cardiology & Radiology
- Abdomen Imaging
- Cardiac Imaging
- Chest Imaging
- Head Imaging
- Neck Imaging
- Obstetrical Ultrasound Imaging
- Oncology Imaging
- Pelvis Imaging
- Peripheral Nerve Disorders (Pnd) Imaging
- Peripheral Vascular Disease (Pvd) Imaging
- Spine Imaging
- Outpatient Medical Oncology
- Outpatient Sleep
- Outpatient Specialty Drug
- eviCore Provider Meeting FAQs
eviCore preauthorization's for outpatient molecular and genomic testing and outpatient radiation therapy can be obtained using one of the following methods:
- The eviCore Healthcare Web Portal is available 24x7. After a one-time registration, you are able to initiate a case, check status, review guidelines, view authorizations/eligibility and more. The Web Portal is the quickest, most efficient way to obtain information.
- Providers can call toll-free at (855)252-1117 between 7 a.m. to 7 p.m. (local time) Monday through Friday.
- More specific program-related information can be found on the eviCore implementation site .
- Refer to the eviCore implementation site and select the BCBSMT health plan for provider training orientation presentations.
* eviCore is a trademark of eviCore healthcare, LLC, formerly known as CareCore, an independent company that provides utilization review for select health care services on behalf of BCBSMT.
** Preauthorization determines whether the proposed service or treatment meets the definition of medical necessity under the applicable benefit plan. Preauthorization of a service is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member's policy certificate and/or benefits booklet and or summary plan description. Regardless of any preauthorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.