Provider Solutions: Overview

eviCore is committed to improving the experience (for administrators, clinicians and patients) and reducing the complexities and costs involved in securing prior authorization (PA) for medical procedures and tests. Our end-to-end prior authorization solution simplifies and automates the entire process from order to decision, reducing operating costs, denials, and delays. A clinical decision support (CDS) tool guides decision making at the point of order. Our workflow application (intelliPathSM) makes it easy to submit PA requests, provide required clinical information, and track status. All without picking up the phone or sending a fax.



Currently, providers must use a variety of online portals, as well as phone and fax, to request prior authorization from the multiple health plans and benefit managers with whom they interact. 


With intelliPath, providers and their staff access a single, unified work queue to submit and track cases for any payer, vastly simplifying the process. The solution is integrated with major EHRs so that case information is automatically populated from the patient record, reducing manual data entry. For cases managed by eviCore, clinically tuned artificial intelligence (AI) is consulted to speed decision making.


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eviCore Clinical Decision Support (CDS)

eviCore CDS delivers appropriate use criteria to the point of order to help clinicians select the best test or procedure for the patient. It applies eviCore's plan-approved and comprehensive library of guidelines, spanning multiple clinical domains. CDS is proven to reduce unnecessary utilization when used as part of an end-to-end solution with eviCore's prior authorization solutions. The eviCore Clinical Decision Support system is CMS-certified to meet the 2020 mandate for use of CDS for advanced imaging. 


See: CMS Fully Qualifies eviCore's Clinical Decision Support Mechanism

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