Nov 20th 2020

Ask eviCore: Workflow Updates

Hi, I’m Mark Tate, and my Provider Experience team is working hard every day to make your experience with eviCore easier, faster, and more collaborative. This edition of Ask eviCore answers a few questions we’ve been receiving lately and focuses on how eviCore is using technology to improve the prior authorization process and get to yes faster! 


Why might I be experiencing delayed turnaround times?


Earlier in 2020, due to the pandemic, there was a period of about 6 months when patients were sheltering-in-place and weren’t going to their doctors. This created a backlog of medically necessary tests, treatments, and procedures that we’re now processing as prior authorization requests. Currently, the eviCore team is reviewing extremely high numbers of cases, but we’re working as quickly as possible to help you help your patients. We appreciate your patience and understanding as we all navigate the exigencies of COVID-19.


I’ll provide more detail on eviCore’s new technology below, but some of you have asked whether its implementation is the cause of the delays. I want to assure you that it’s not, and in fact, these new technology enhancements are going to ensure the prior authorization process is much more efficient for you going forward.


Why am I no longer seeing the clinical questionnaires when I submit a prior authorization request on some of my requests?


eviCore is focused on reducing administrative responsibilities in the prior authorization process, which is why we’ve recently integrated new technology into the existing prior authorization workflow. This technology uses data we’ve gathered from more than 140 million patient cases to train its AI algorithms. It is able to identify patterns leading to quicker approvals for medically necessary tests, treatments, and procedures with a high degree of confidence.


Studies show that these algorithms are better predictors of medically appropriate requests than traditional clinical surveys. This technology was designed specifically to save you and your staff time and effort and increase the likelihood of real-time authorizations.


Over the next several months, you will notice a gradual approach to removing clinical surveys in your workflow when submitting a prior authorization request. This is because this technology will be integrated into your workflow—eliminating the need for you to fill out those lengthy surveys. Please note: this will only apply to diagnostic imaging codes.


Why am I being asked to upload clinical data at the beginning of the prior authorization process?


This is also part of our effort to make the prior authorization process more efficient. If your case does not receive an real-time approval, you will be asked to upload all clinical documentation at the beginning of the case.  By having you upload clinical data at the beginning of the case submission process, it reduces the amount of outreach the eviCore team has to send back to your office staff. Once you upload clinical data to the system, it will go directly to the clinical team for review.  The clinical team can then, if needed, ask for specific required clinical documentation that’s needed to complete the review of your case, rather than ask you to provide that information along the way.


And our data analysis shows the improvements are working! We’ve seen a 25-percent reduction in talk times for providers and a 50-percent reduction in outreaches from eviCore to provider offices for additional clinical documentation. Overall, providers are saving 2 minutes per each case in clinical submission time.


If you’d like to learn more about this technology, here are some additional resources:


·      Webinar with Dr. Eric Gratias and Jonathan Murray: Prior Authorization Needs to Evolve

·      Infographic: How AI Can Make Hospital Administration More Efficient

·      Podcast: Our Technology is Speaking your Language

·      Blog: What Can Natural Language Processing Offer Your EHR?

·      Podcast: We're Talking High-Tech Prior Auth!

If you have a question or a topic suggestion for a future edition of the Ask eviCore column, or you’d like to share your feedback about our prior authorization process or this newsletter, email Jackie Jenkins, the National Provider Advocate on my team, at By working together, we can ensure your patients get the best possible care. Thanks for reading this edition of Ask eviCore


Mark Tate

Master of Physical Therapy

Vice President, eviCore Provider Experience