FirstCarolinaCare Provider Resources

FirstCarolinaCare is pleased to announce that we will be expanding our partnership with EviCore by Evernorth to include prior authorization management for Commercial and Medicare networks for Vascular Intervention services for dates of service January 1, 2024 and beyond.

Additional information regarding current and upcoming programs can be accessed via the General Resources and Solution Resources tab above. More details to come.

EviCore is pleased to provide prior authorization review for select outpatient services for FirstCarolinaCare for dates of service January 1, 2021, and beyond. This includes both Medicare Advantage as well as Commercial Self-Insured and Fully Insured plans. Prior authorization will be required for the following services:

• Cardiac Imaging- Stress testing, Echocardiography, and diagnostic Heart Catherization
• Cardiac Implantable Devices
• CAR-T Cell Therapy
• Genomic Lab
• Medical Oncology- Medical and Pharmacy Benefit
• Radiation Oncology
• Radiology -CT, MRI, PET, Nuclear Medicine, Ultrasound (including OB)
• Musculoskeletal - Interventional Pain, Spine and Joint Surgery
• Musculoskeletal – Specialized Therapies (PT/OT/ST/Chiropractic)
• Sleep Management-Diagnostic test, Pap Therapy Devices and supplies, Therapy support

Note: All Medicare Advantage Plans are effective for Dates of Service occurring on or after 1/1/2021. Commercial Plans (Self Insured and Fully Insured) have a Rolling Go Live implementation effective with the date each group renews in the 2021 plan year.