As part of our continued effort to provide a high quality user experience while also ensuring the integrity of the information of those that we service is protected,
we will be implementing changes to evicore.com in the near future.
Beginning on 3/15/21, web users will be required to log in to evicore.com in order to check the status
of authorization request(s). Please click here to register for an account.
Resources
I Would Like To
Learn How To
Frequently Asked Questions
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Providers
- Getting Started
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Active Case
- How can I check my authorization status?
- What is an online clinical consultation?
- What do I do if a member’s eligibility is incorrect or not on file?
- I need to change the date on my request. What is the fastest way to do this?
- I need to change the CPT code on my request. What is the fastest way to do this?
- Denied Case
- Patients
- Health Plans
What are my options following a denial?
Navigating the letter from eviCore: If the request from your healthcare provider doesn’t meet the evidence-based guidelines, you’ll receive a letter from eviCore letting you know it wasn’t approved and why. The “why” will include a reference to the medical guidelines in question, which are completely transparent and available on eviCore’s website for your review. Sometimes these letters may include an alternative course of action that would better meet the guidelines. To comply with certain health and regulatory requirements, these letters can be a bit wordy and confusing, so here are some options for potential next steps.
Option 1: Peer-to-Peer Discussion
If you want additional review of the initial request, you can ask your healthcare provider to set up a peer-to-peer discussion with one of eviCore’s medical directors, who will be from your provider’s specialty. This allows for the exchange of additional clinical information about your situation without the “red tape” of a formal appeal and often results in a better decision about whether to do a certain test, treatment or procedure. While this conversation must be conducted by your provider, he or she can easily schedule it online here at a time that’s convenient.
Option 2: Formal Appeal
The letter you receive will also outline how you can formally appeal the decision through a process with your health plan. It provides greater detail on the steps and process. Unlike the peer-to-peer with your provider, this process can be undertaken by the health plan member directly, but it can take longer and involve more steps.