What claims are subject to claims review?

Technically, all claims for CPT codes that are in scope are subject to claims review. eviCore reviews the claim to make sure it received any necessary prior authorization. In addition, eviCore automatically applies over 44,000 lab-specific claim rules to ensure appropriate reimbursement for medically necessary tests. The vast majority of these rules apply to low-cost, high-volume tests that are not as amenable to prior authorization.

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