Cardiology: Overview

eviCore’s Cardiology solution applies solid evidence-based principles to all decision-making to decrease the utilization of inappropriate cardiac imaging tests, diagnostic services, and implantable devices, and eliminate unnecessary and duplicative tests that generate higher costs and avoidable patient risks.

  

Everyone benefits through better outcomes

  • Plans

    Our Cardiology solution reduces the administrative burden for our clients and provides cost savings by reducing inappropriate utilization while increasing the quality of treatment their members receive.

  • Providers

    Our Cardiology solution interacts with providers during implementation and then ongoing to render support and educational resources, as well as obtain feedback for program improvements. Additionally, eviCore assists risk-bearing providers with innovative features of our Cardiology solution such as our Clinical Decision Support tool.

  • Patients

    Our Cardiology solution improves patient safety through the reduction of unnecessary testing. That helps reduce radiation exposure, the use of intravenous contrast agents, and the need for downstream procedures.

  

Criteria & Easy Approval Process: Leading To Better Decisions

Nurse Review MD Review Peer to Peer Predictive Intelligence and Clinical Decision Support Appropriate Decision Web Phone Fax Methods of Intake REAL-TIME DECISION
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Educational Tools

Here you’ll find all the resources, tools, and links to know more about eviCore’s Cardiology solution.​

  

The more we know, the better the outcome

A list of the most common Cardiology queries is provided below. For more detailed information, visit the Contact Us page.

What types of cardiology procedures require clinical certification (pre-certification)?

The procedures requiring clinical certification generally include the following:*

  • Advanced Imaging and Diagnostic Services:
    - Stress testing
    - Myocardial perfusion imaging (SPECT and PET)
    - Stress echocardiography
    - Echocardiography: transthoracic and transesophageal
    - Diagnostic heart catheterization
  • Implantable Device Services:
    - Pacemakers
    - Implantable cardioverter defibrillator (ICD)

*The requirements for clinical certification of specific procedures can vary by health plan.

What is included in the Cardiology solution?
  • Clinical Review- eviCore uses cutting-edge technology, including our proprietary predictive intelligence and clinical decision support, to assist in the clinical review process. Additionally, our experienced team of more than 450 nurses and 190 medical directors ensure that members receive the most clinically appropriate decisions.
  • Provider Education- we interact with providers during implementation and then ongoing to render support and educational resources, as well as obtain feedback for solution improvements.
  • Network Analysis- eviCore maintains an experienced, dedicated staff tasked with reviewing the adequacy, value, and performance of the client’s network to ensure it meets the current and future needs of members and clients.
  • Analytics and Reporting- we utilize a robust analytics platform that can provide customized reports to meet our client’s data management needs. eviCore’s reporting capabilities and analytical architecture serves as the information and analytics platform to meet our client’s needs now and in the future.
What additional tools are available with the Cardiology solution?
  • Payment Integrity (Claims StudioSM): Our proprietary system, Claims StudioSM, delivers incremental savings through a rigorous focus on accurate claims payment that can be implemented as an extension of the client’s existing claims workflow. With Claims StudioSM, the claim is pended in the host system; sent to eviCore, where it is adjudicated with eviCore’s proprietary claims engine; and then returned to the host system for payment – all in the same day.
  • Privileging and Assessment Tool: eviCore offers a Privileging and Assessment program to help clients make quality services available through their existing networks; we provide clients with information about facility accreditation, staff training and experience, and equipment status and maintenance so they can determine which non-affiliated facilities are qualified to delivery specific imaging services.