Providers | Prior Authorization Automation

EviCore intelliPath®

EviCore intelliPath® is EviCore’s electronic prior authorization solution housing a suite of capabilities that simplify and automate the prior authorization process. These capabilities include connectivity, real-time decisions, case validation, and simplified clinical surveys.

EviCore intelliPath® is deployed by provider organizations to automate and simplify submitting and tracking requests for prior authorization. EviCore intelliPath® streamlines operations within a single easy-to-use application that integrates with major electronic health record (EHR) vendors. Provider costs are reduced and decisions are communicated in real time, reducing delays.

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Administrative Cost Savings

EviCore’s medical benefits management solutions are proven to reduce unnecessary and potentially harmful tests and procedures. However, securing prior authorization can impose a high burden on providers and their staff. For example, providers must hire dedicated administrative staff to request and track cases, and clinicians typically must allocate time to provide details on the patient’s medical diagnosis.

Rather than implementing an abundance of tools, multiple health plan portals, and time-consuming manual interactions, intelliPath simplifies and streamlines PA operations with a single, integrated application that leverages providers’ substantial investment in EHRs. It automatically incorporates case details from the patient’s chart and fits seamlessly into clinical and revenue cycle workflows.

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Clinical Efficiency

IntelliPath integrates with EviCore’s utilization management system and those of other UM providers. This expedites communication of critical information (e.g., automated approval, no PA required, or additional clinical information needed). With the approval or denial in hand, providers can schedule patients for procedures or order alternative tests or treatments in a timely fashion. 

Benefits for Patients, Providers, and Health Plans 

  • Lower costs for health care-delivery organizations
  • Reduced frustration and more transparency for patients and clinicians
  • Better network relationships for health plans
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Benefits for Patients, Providers, and Health Plans

  • Lower costs for healthcare-delivery organizations
  • Reduced frustration and more transparency for patients and clinicians
  • Better network relationships for health plans

 

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Easy to Deploy

IntelliPath is a cloud-based application that seamlessly connects to data in the EHR through approved application programming interfaces (APIs). Currently supported EHRs include solutions from Athenahealth, Allscripts, Cerner, and Epic that have been adopted by many health systems and medical groups. PA requests are generated automatically when an order is placed or a procedure is scheduled in the EHR. For ordering providers that are not on a health system EHR, a portal version of the software is available. 

 

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End-to-End Automation

IntelliPath replaces costly manual processes and disconnected tools with an automated solution that streamlines the process from submission to decision.

  • Manages all PA activity in a single work queue
  • Automatically creates a case from an order or scheduled activity
  • Electronically submits case for approval or review
  • Dynamically updates case status and logs decisions

FAQs

For healthcare providers interested in deploying intelliPath, learning if your health system is connected, or viewing a demonstration, please contact intellipath-sales@evicore.com. For health plans that wish to offer intelliPath to their provider networks, please connect with your EviCore Client Relationship Executive or Client Services team.

IntelliPath fully supports industry-standard transactions for medical benefits PAs, including EDI X12, EDI278, and EHR-specific APIs. IntelliPath is also available via Epic’s App Market. 

EviCore intelliPath® is a single application that can be used for any plan or procedure, so it simplifies your prior authorization workflow by eliminating the need to visit different portals for the variety of plans and prior authorization programs your practice needs to access. Further, EviCore intelliPath® integrates into health system EHRs. This means that prior authorization requests are automatically triggered from either an Order or Schedule activity, and case information is automatically populated from data in the patient’s record, reducing the time required for manual data entry and helping to avoid errors.

We are committed to lowering the barrier to evidence-based care by reducing the burden of prior authorization. EviCore intelliPath® is one important aspect of how we are delivering on that commitment.

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