New eviCore Email-Notification for Utilization Management (UM) Decisions
On 9/15/18 eviCore healthcare (eviCore) will begin notifying providers by email for all cases that are initiated through the eviCore web portal.
A few notes on this coming change:
- The email functionality is fully compliant with the Health Insurance Portability and Accountability Act (HIPAA). No protected health information is shared in the email. This is only a notification that a determination has been made on a specific case, or a case is still in process, with instructions to login to the eviCore web portal for details.
- The email notification will only apply to cases that are initiated through the eviCore web portal.For cases initiated by phone and/or fax to eviCore, the provider will continue to receive faxed notifications from eviCore.
- This notification will only be sent to health care providers and their authorized contacts who have registered with a valid email address on the eviCore web portal. Patients will continue to receive mailed letters from eviCore.
- For any email rejections (e.g., user email mailbox is full, etc.), the provider notification will be resent by fax.
- Current options to request a faxed copy of the authorization through eviCore will remain in place.
Below is an example of the email notification providers may receive.
Subject: eviCore healthcare E-Notification: Case # 123456789 has been Updated
There has been an update issued for Case ID # [Enter Case Number] requested by NPI [Enter NPI Number]. To retrieve this information, please click on the link provided below to log in to the Web Portal and use the NPI and Case ID option to search for Case ID # [Enter Case Number] and NPI [Enter NPI Number].
As part of our initiative to speed up communications and eliminate waste, there will not be a separate fax sent to you for this approval unless you request it.
Please contact eviCore at 1-855-252-1117 if you need more information.
Please note that the fact that a service has been preauthorized/pre-certified is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered.
eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSMT. eviCore is wholly responsible for its own products and services. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by eviCore.