1. Sleep Diagnostics − eviCore currently manages medical necessity review and PA for both attended sleep studies in a facility and home sleep testing (HST). In our programs, requests for attended sleep studies or HSTs are evaluated against our robust criteria.
2. Sleep Apnea PAP Therapy − eviCore can manage all durable medical equipment PAP therapy codes and supplies through medical necessity review and PA.
3. PAP Compliance − eviCore developed an innovative and effective system that monitors how well patients in sleep apnea treatment are complying with PAP therapy guidelines. Our system, called TherapySupportSM, objectively monitors PAP usage, and intervenes with DME and providers when patients are not meeting targeted usage levels.
4. Network Management − In addition to the UM of sleep diagnostics and therapy requests using evidence-based guidelines, the eviCore Sleep solution offers a network quality assessment and verification program as well as access to our sleep network. The goal of both approaches is to deliver high-quality providers of facility-based testing, home-based testing, and DME to our clients’ members.
5. IT infrastructure − The Sleep solution resides on the same IT platform as all other eviCore solutions. Our IT infrastructure offers a wide range of flexibility in application and can accommodate a more streamlined request process for those providers who have demonstrated an inclination to order procedures in accordance with evidence-based medicine.