Health Plans | Prior Authorization Automation eviCore intelliPath®

eviCore intelliPath® is eviCore’s electronic prior authorization solution housing a suite of capabilities that simplify and automate the prior authorization process. These capabilities include connectivity, real-time decisions, case validation, and simplified clinical surveys.

eviCore intelliPath® is deployed by provider organizations to automate and simplify submitting and tracking requests for prior authorization. eviCore intelliPath® streamlines operations within a single easy-to-use application that integrates with major electronic health record (EHR) vendors. Provider costs are reduced and decisions are communicated in real time, reducing delays.

Administrative Cost Savings

eviCore’s medical benefits management solutions are proven to reduce unnecessary–and potentially harmful–tests and procedures. But securing prior authorization can impose a high burden on provider organizations; for example, dedicated administrative staff are hired to request and track cases, and clinicians typically must allocate time to provide details on the patient’s medical diagnosis.

In place of implementing an abundance of tools, multiple health plan portals, and time-consuming manual interactions, eviCore intelliPath® simplifies and streamlines prior authorization operations with a single, integrated application. eviCore intelliPath® leverages the substantial investment in EMRs on the part of provider networks. It automatically incorporates case details from the patient’s chart and fits seamlessly into clinical and revenue cycle workflows.

Clinical Efficiency

Further, eviCore intelliPath® integrates with eviCore’s utilization management system (and those of other UM providers). This speeds communication of critical information (e.g., automated approval, no prior authorization required, or additional clinical information is needed for a decision to be made). With the approval or denial in hand, patients can be scheduled or alternative tests or procedures ordered in a timely fashion.

Benefits for Patients, Providers, and Health Plans

  • Lower costs for healthcare-delivery organizations
  • Reduced frustration and more transparency for patients and clinicians
  • Better network relationships for health plans

FAQs

How do we get started?

Healthcare providers that are interested in deploying eviCore intelliPath®, learning if your health system is connected, or viewing a demonstration of the software, should contact intellipath-sales@evicore.com.

Health plan client who would like to offer eviCore intelliPath® to their provider networks should connect with their Client Relationship Executive or Clients Services team.

Which EHRs does eviCore intelliPath® support?

eviCore intelliPath® fully supports industry standard transactions for Medical Benefits Prior Authorizations, including EDI X12, EDI278 as well as EHR specific APIs. eviCore intelliPath® is also available via Epic’s App Orchard.

We already use the eviCore portal. Why would I switch to eviCore intelliPath®?

eviCore intelliPath® is a single application that can be used for any plan or procedure, so it simplifies your prior authorization workflow by eliminating the need to visit different portals for the variety of plans and prior authorization programs your practice needs to access. Further, eviCore intelliPath® integrates into health system EHRs. This means that prior authorization requests are automatically triggered from either an Order or Schedule activity, and case information is automatically populated from data in the patient’s record, reducing the time required for manual data entry and helping to avoid errors.

Why is eviCore providing eviCore intelliPath® free of charge for eviCore-managed lives?
We are committed to lowering the barrier to evidence-based care by reducing the burden of prior authorization. eviCore intelliPath® is one important aspect of how we are delivering on that commitment.

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