The Health Plan Provider Resources
The Health Plan (THP) is pleased to expand its ongoing partnership with EviCore healthcare to provide medical necessity review and authorization for members receiving services for the following that were previously provided through Palladian Health:
Musculoskeletal (MSK)
- Specialized Outpatient Therapies
- PT and OT
- Chiropractic Care
- Pain Management
Additionally, EviCore healthcare will begin to review and authorize:
- Joint and Spine surgery
These changes will become effective on December 13, 2021 for dates of service beginning January 1, 2022 and will affect THP members belonging to the following lines of business:
- Commercially insured fully-funded plans (including HMO, PPO, POS, and WV PEIA plans)
- THP Mountain Health Trust (Medicaid and WVCHIP)
- Medicare (including SecureCare HMO, SecureChoice PPO, and Dual Eligible Special Needs Plans)
Services performed without authorization may be denied for payment, and you may not seek reimbursement from members.
POST-ACUTE CARE PROVIDER CAPABILITY SURVEY
Our Provider Survey is designed to receive information about your facility to better understand the services you offer as well as your operations and clinical capabilities. Please click here to participate in our brief survey.
Durable Medical Equipment
Sleep
Cardiovascular
Radiology
Musculoskeletal
Post-Acute Care
Need Help?
Registration Instructions
EviCore highly recommends providers take full advantage of the online capabilities at https://www.evicore.com/provider
Here you can request prior authorization, review our nationally accepted evidence-based guidelines, and receive announcements about program updates. Access requires only your email address and a brief registration.