Frequently Asked Questions

• Getting Started
  • How to register
  • How to start a new prior authorization
• Active Case
  • I need to change the CPT code on my request. What is the fastest way to do this?
  • I need to change the date on my request. What is the fastest way to do this?
  • What do I do if a member’s eligibility is incorrect or not on file?
  • What is an online clinical consultation?
  • How can I check my authorization status?
• Denied Case
  • What do I tell my patient when their case is denied?
  • What are my options when a case is denied?

• Getting Started
  • What is prior authorization?
  • Who is EviCore?
• Checking the Status of My Case
  • My procedure is scheduled soon and I haven’t heard if my case is approved or not. Should I reschedule?
• Denied Case
  • Why was my test, treatment, or procedures not approved?
  • What are my options following a denial?
• Cardiovascular
  • How do I know when my test has been authorized?
  • What if my tests do not get approved?
  • How do I obtain clinical certification for cardiovascular tests?
• Consumer Engagement
  • I got a message from a SmartChoice representative asking me to call back; why are you calling me?
  • Why didn't you call me the last time I had a procedure?
  • How will my doctor know where I am going?
  • Don’t I have to go to a hospital for my procedure?
  • How did you get my phone number/information?
• Musculoskeletal
  • What can physical therapy do for my lower back pain?
  • What can chiropractic services do for my lower back pain?
  • What is chronic pain?
  • What are some facts about back pain
• Medical Drug
  • How does my doctor access the Medical Drug Management solution?

• Getting Started
  • Who is EviCore healthcare?
  • How does EviCore interact with providers?
• Our Solutions
  • Cardiovascular
    • What is included in the Cardiovascular solution?
    • What additional tools are available as add-on programs to the Cardiovascular solution?
    • What types of cardiovascular procedures require prior authorization?
  • Comprehensive Oncology
    • What is included in eviCore’s Comprehensive Oncology program?
    • What digital resources can I access to find out more comprehensive oncology information?
  • Laboratory Management
    • How are policies created and updated?
    • What claims are subject to claims review?
    • How does EviCore handle large gene panels?
  • Medical Oncology
    • What is included in the Medical Oncology program?
    • What digital resources can I access to find out more medical oncology information?
  • Musculoskeletal
    • What services are managed through the Musculoskeletal Pain Management Program?
    • What services are managed through the Musculoskeletal Therapies Program?
    • What services are managed through the Musculoskeletal Surgical Program?
    • Where are Musculoskeletal Program guidelines and how are they accessed?
  • Post-Acute Care
    • Who and what guides our Post-Acute Care?
    • Where do you provide Post-Acute Care?
    • What is Post-Acute Care?
    • Why is Post-Acute Care Needed?
    • How does EviCore interact with Post-Acute Care patients?
  • Radiation Oncology
    • What is included in the Radiation Oncology program?
    • What digital resources can I access to find out more radiation oncology information?
  • Sleep
    • What is included in the sleep solution?
    • What is TherapySupport℠?
    • What types of services are managed under your sleep solution?
    • How does EviCore communicate with the patient’s provider?
    • Do you offer a mandatory prior authorization program for all sleep studies?
  • Medical Drug Management
    • What is included in the Medical Drug solution?
    • What if the request does not meet clinical criteria?
  • Consumer Engagement
    • What is SmartChoice?
  • intelliPathSM ePA
    • How do we get started?
    • Which EHRs does EviCore’s intelliPath ePA support?
    • We already use the EviCore portal. Why would I switch to intelliPath ePA?
    • Why is EviCore providing intelliPath ePA free of charge for EviCore-managed lives?