Implant Management

Health Plans | Payment Integrity Implant Management

To address the inordinately high costs and large product-variation of implant devices, eviCore’s Implant Management program utilizes evidence-based clinical guidelines to detect safety and quality gaps in implant usage, and a thorough claims-review process to recoup potential overpayments.

Managing Cost

A key component of eviCore’s innovative programs for managing implant costs rest on insight info—and oversight of—implantable device claims. eviCore addresses the discrepancies in implant-related claims that can contribute to wide variations in cost for surgeries involving implants.

Claim Review Process

To combat implant cost problems, eviCore utilizes a 4-level claims-review process:

Outlier analysis based on cost
Pricing benchmark analysis
Intra-operative variability check
Technical review with internal experts.

Benefits

eviCore promotes transparency and predictability into device spend, while lowering medical costs for clients and patients. At the same time, our Implant Management program promotes safety and quality with our recall database—a differentiator in the marketplace, as it offers health plans a centralized view of recall information.