The procedures requiring clinical certification generally include the following:*

•  Stress testing
  • Myocardial perfusion imaging (SPECT & PET)
  • Stress echocardiography
• Cardiac CT and MRI
• Echocardiography 
  • Transthoracic (TTE)
  • Transesophageal (TEE)
• Diagnostic heart catheterization
• Pacemakers
• Implantable cardioverter defibrillator (ICD)
• Vascular interventions 
• Percutaneous coronary intervention

*The requirements for clinical certification of specific procedures can vary by health plan. In some instances, covered procedures may be reviewed through a claims-based post-service process.

• Clinical Review – EviCore uses cutting-edge technology, including our proprietary predictive intelligence and clinical decision support, to assist in the clinical review process. Additionally, our experienced team of nurses and board-certified cardiologists ensures that members receive the most clinically appropriate decisions.
• Provider Education – We interact with providers during implementation and on an ongoing basis to render support and educational resources, as well as obtain feedback for solution improvements.
• Analytics and Reporting – We utilize a robust analytics platform that can provide customized reports to meet our client’s data management needs. EviCore’s reporting enhances our data management and analytical architecture to create a present and future solution that serves as the information and analytics platform for the enterprise and its clients.

• Payment Integrity (Claims Studio): Our proprietary system, Claims Studio, delivers incremental savings through a rigorous focus on accurate claims payment that can be implemented as an extension of the client’s existing claims workflow. With Claims Studio, the claim is pended in the host system and then sent to EviCore, where it is adjudicated with eviCore’s proprietary claims engine, and then returned to the host system for payment – all in the same day.
• Consumer Engagement (SmartChoice): EviCore’s innovative SmartChoice program serves as a patient outreach service to educate health plan members on available options for the location of their advanced cardiac diagnostic imaging procedure. By presenting lower-cost, convenient, and high-quality options, SmartChoice empowers members to make more informed comparisons and choices.