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Who We Are

eviCore is the recognized industry leader in medical benefits management, with more than 25 years of experience covering 100 million lives. Our technological capabilities, coupled with our forward-thinking approach, afford us opportunities to be more innovative—creating new ways to solve problems in utilization, cost, quality outcomes, and cost containment, especially as the market adopts value-based care. We have the best benchmark data, the most thorough understanding of payer markets, and the deepest clinical expertise with more than 1,100 full-time clinicians. We maintain the industry’s most comprehensive, well documented, and up-to-date clinical guidelines. With in-depth clinical expertise, we are a provider-driven organization with many in-house specialists who understand the concerns of your provider community and are sensitive to them.

Benefits

Delivering the market’s most effective medical benefits management isn’t just our business, it’s our moral imperative. Companies that partner with eviCore gain the following value:

  • Financial Impact

    eviCore maximizes medical cost savings by ensuring the most appropriate quality of care and highest operational efficiency. We accept financial responsibility for the medical spend that we manage and we guarantee savings on day one of management.

  • Member Experience

    eviCore improves the quality of care patients receive without impeding the process or creating unnecessary gaps in care. All determinations are based on the individual patient’s clinical information, history, and current presentation, preventing duplication of previously unsuccessful treatments.

  • Provider Experience

    We own the entire lifecycle of the provider experience, from onboarding, to process support, post-decision support, and all the way through claims-payment support. We’re bringing new awareness and urgency to supporting providers as their primary point of contact and easing their growing administrative burdens.

  • Quality Improvement

    eviCore applies the latest evidence-based guidelines, which are fully transparent and based on criteria from medical societies (such as the American College of Cardiology, American College of Radiology, etc.), as well as scientific evidence from recently published, peer-reviewed medical literature.

Clinical Guidelines

eviCore offers a variety of solutions to ensure patients get the right care when and where it’s needed. Each solution uses evidence-based clinical guidelines to help patients avoid tests, treatments, or procedures that research has shown are ineffective, unnecessary, dangerous, or unusually costly. eviCore's evidence-based guidelines are intended to support sound medical judgment, not replace it. Only an eviCore physician or therapist can make the determination that care is medically inappropriate. While evidence-based guidelines are generally developed from large-scale studies and statistics, eviCore provides ready, clear channels, including peer reviews and appeals, by which clinicians can advocate for a patient’s unique circumstances or needs.

Provider Experience

With more than 25 years of experience in utilization management, eviCore understands that maintaining a supportive provider experience requires more than supplying a few training sessions and establishing a phone line for questions. We recognize that providers today navigate a complicated healthcare system while trying to make the best medical decisions for their patients. In addition, they can become overwhelmed with administrative burden. eviCore’s approach to supporting the optimal provider experience is dynamic and proactive. We offer ongoing provider touchpoints, including a team dedicated to on-site visits, surveys, and tracking and receiving feedback from both providers and our clients. We also provide helpful resources on how to navigate the prior authorization process, including provider playbooks, and tips on how to avoid a peer-to-peer phone call. Based on the feedback we receive, we continuously strive to improve our operational efficiencies through ongoing web enhancements and development of innovative support measures for our providers.

Clinical Support

eviCore’s team includes 300 physicians and therapists and nearly 800 nurses with experience in multiple specialties; their sole job is to protect your members’ health by making sure that all the care you’re provided is backed by the latest science.

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  • UTILIZATION MANAGEMENT
    view all
  • CARE COORDINATION
    Post-Acute Care
  • PAYMENT INTEGRITY
    Implant Management
  • MEMBER ENGAGEMENT
    Consumer Engagement
  • BENEFIT PROTECTION
    Embarc Benefit ProtectionSM

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