May 12th 2020

Ask eviCore: COVID-19 Support

Hi, I'm Mark Tate, and I lead eviCore's Provider Experience team. I hope you’re all staying healthy and safe during this challenging time. In this edition of Ask eviCore, we wanted to answer some of your questions about how we’re adapting to support providers and patients during the COVID-19 pandemic. As you all know, this is a fluid situation. We’re working closely with our clients to put the right solutions in place based on geographic location and member demographics, so please keep in mind that policies or protocols could vary among the respective states and health plans.

 

Are you extending authorizations?

eviCore is implementing a temporary adjustment to the authorization end dates for the majority of our cases. For all prior authorization programs except Medical Oncology, Specialty Drug, Home Health, core Post-Acute Care (PAC) services, and select durable medical equipment (DME) services, we have shifted the authorization span to a 180-day period. This change was made effective on March 26, 2020. 

 

For services not receiving a temporary adjustment, prior-auth extensions of these programs are generally not elective, so members will continue to receive treatment as usual. In addition, in select programs such as Medical Oncology, authorizations are already valid for more than 180 days, so those durations were not modified for COVID-19. For PAC services, granting an open-ended, 6-month stay at a facility could result in unnecessarily tying up beds that could be used by another patient with a more critical need. (See more on PAC below.) We are also working with our clients on an ad hoc basis to extend end dates as needed for existing authorizations that were approved prior to March 26, 2020.

 

Can I still contact eviCore as needed?

Yes. We don’t anticipate any disruption to our services. We have capacity for nearly all of our staff to connect remotely. Feel free to continue reaching out as you normally would!

 

Are there any changes to the Post-Acute Care program?

We are working to ensure patients can quickly and seamlessly enter skilled nursing facilities (SNFs) and long-term acute-care hospitals (LTACs) to help preserve as much acute-care hospital space as possible for patients with COVID-19. Patients requiring SNF or other levels of service following an acute-care hospital stay will receive automatic prior approval. SNFs can also accept eviCore-delegated members directly from home or an emergency department, so they can avoid hospital stays altogether. Ventilator patients requiring LTAC-level of care will receive automatic prior approval; all other service types will be approved through a streamlined process to preserve as many ventilator-capable beds as possible.

 

Patients requiring an inpatient rehabilitation facility (IRF) will be approved. However, CMS has directed that IRF beds should be preserved as potential acute-care beds, so we’re asking our team to use their best judgment and send patients to an alternative level of care whenever possible.

 

All home health agencies will receive automatic approval. We’re asking them to submit clinical information to eviCore within 3 days of the initial request. Additionally, all home-based oxygen and ventilator requests will receive automatic prior approval. Finally, replacements for DME that is lost, damaged, or otherwise unusable will be approved without standard requirements, such as a physician’s order, medical necessity documentation, or face-to-face evaluations.

 

How are you handling chest CTs that are used for COVID-19 diagnosis?

We’re working to make sure patients suspected of having COVID-19 are getting the necessary testing as quickly as possible. As a result, eviCore is working with providers to rapidly approve CT scans for known or clinically suspected COVID-19 cases, and we’re tracking the number of cases that are approved for this indication. Any of the following can be authorized when requested if COVID-19 is known or suspected in the patient:

- CPT® 71250: CT Chest without contrast

- CPT® 71260: CT Chest with contrast

- CPT® 71270: CT Chest without and with contrast

 

If you’d like more information on the imaging guidelines for COVID-19, the following article provides helpful information: https://bit.ly/2PTSqYr.

 

Thank you for your continued partnership with eviCore, and be well.

Mark Tate

Master of Physical Therapy

Vice President, eviCore Provider Experience