Provider Solutions: Overview

We’re committed to improving the experience of administrators, clinicians, and patients who work with eviCore. Our Provider Solutions are designed to reduce the complexities and costs involved in securing prior authorization (PA) for medical procedures and tests. The eviCore intelliPath™ electronic prior authorization solution (intelliPath ePA) unifies the entire pre-approval process – from submission to decision – into a single application integrated with the patient’s electronic health record (EHR). The result is reduced operating costs, denials, and delays. A companion clinical decision support tool, intelliPath CDS, uses eviCore’s clinical guidelines and CMS-approved Appropriate Use Criteria (AUC) to guide decision making at the point of order and support adherence to evidence-based guidelines.


eviCore intelliPath℠

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 ePA, providers and their staff access a single, centralized work queue to submit and track cases for any payer, greatly simplifying the process. The solution is integrated with major EHRs. Case information is automatically populated from the patient record, reducing manual data entry. The prior authorization request process is triggered automatically from an order or schedule event in the EHR, speeding the process. intelliPath connects seamlessly to eviCore's UM system, so cases can be automatically submitted and decisions are immediately communicated into the work queue. 

intelliPath ePA makes it easy for providers to submit PA requests, provide required clinical information, and track status. All without picking up the phone or sending a fax.


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eviCore intelliPath℠ CDS

To help clinicians select the best test or procedure for the patient, eviCore's CDS delivers appropriate use criteria to the point of order. It applies eviCore's health plan-approved and comprehensive library of guidelines, spanning multiple clinical domains. When deployed as part of an end-to-end solution with intelliPath ePA, CDS can reduce unnecessary utilization and help providers make choices consistent with payer medical policy. eviCore's CDS is CMS-certified to meet the 2020 mandate for the use of CDS for advanced imaging, so it can ensure appropriate use and reimbursement from Medicare as well as eviCore's commercial health plan clients.