Frequently Asked Questions

Sleep Diagnostics − EviCore currently manages medical necessity review and PA for both attended facility sleep studies and home-based sleep apnea testing (HSAT). In our programs, requests for attended sleep studies or HSATs are evaluated against our proven criteria.
Sleep Apnea PAP Therapy − EviCore can manage all durable medical equipment PAP therapy codes and supplies through medical necessity review and PA.
PAP Compliance − EviCore system, called TherapySupport, objectively monitors PAP usage and intervenes with DME and providers when patients are not meeting targeted usage levels.
Network Management − In addition to the utilization management (UM) of sleep diagnostics and therapy requests using evidence-based guidelines, the EviCore Sleep solution offers a network quality assessment and verification program as well as access to our sleep DME network. The goal of both approaches is to deliver high-quality providers of facility-based testing, home-based testing, and DME to our client’s members.
IT infrastructure − The Sleep solution resides on the same IT platform as all other EviCore solutions. Our IT infrastructure offers a wide range of flexibility in application and can accommodate a more streamlined request process for those providers who have demonstrated an inclination to order procedures in accordance with evidence-based medicine

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