How does EviCore communicate with the patient’s provider?
Communication with referring providers occurs before the Sleep solution starts, and after every request; written notifications are delivered via major methods. In addition, we monitor patients undergoing PAP therapy for sleep apnea treatment, and our Sleep Educators communicate with the referring provider when the patient is not using therapy as prescribed.
Prior to the start of the Sleep solution, EviCore schedules webinars designed to communicate all elements of the Sleep solution to providers. Providers are notified by mailed letter, fax, or email by the health plan and EviCore to attend these presentations. Learning key facets of the solution, the providers are better equipped to secure authorizations for their patients.
In the medical necessity determination process, providers contact EviCore either by Web or phone to initiate requests for sleep diagnostic procedures, PAP therapy devices, and PAP therapy supplies. On the phone, providers or their staff speak with EviCore’s specially trained clinical decision support agents, who are specifically assigned to handle only sleep solution cases. Whether the case is completed on the phone or on the Web, once it reaches a final determination (approved or denied), notification is immediately sent to the provider.