eviCore Authorization
Posted on March 8, 2023
Health New England, in partnership with eviCore Healthcare, our authorization manager for high-cost imaging, sleep study and genetic testing, has made a decision to change the allowed time between approval and rendering of the services with high-cost imaging for all of our lines of business. Effective April 1, 2023, our Commercial, Medicare and Medicaid members will only have a 30-day period for services to be rendered once an authorization request is approved. Currently, we allow 60 days from approval, but our data shows services are being rendered within a 30-day period from the consent. With this timeframe adjustment, we will not only align nicely with what you are doing today, but this will make us parallel with other payers in the state of Massachusetts supporting consistency for our network.
In addition, we understand rare circumstances can occur where our member is unable to make the scheduled appointment in those 30 days. If this were to occur, the rendering provider will need to call eviCore at (800) 918-8924 seeking an exception for the current approved authorization. The information eviCore would need available during this call is the Authorization ID and Case ID or Member ID. The decision to extend the expired authorization will be reviewed on a case-by-case basis.
For more information, please do not hesitate to call your Provider Relations Representative at (800) 842-4464, extension 5000, or send an email to providerrelations@hne.com.
