Among healthcare related organisations, insurers frequently work with third parties to cut maintenance, enhance patient care and cut costs. eviCore healthcare is just one such company that delivers evidence-based medical benefit management services. If you’ve ever wondered, “What insurance companies use eviCore?” this article is your ultimate guide. In this article, we will look at eviCore’s role, and how it relates to the major insurers, and the impact on policyholder.
What is eviCore and What Does It Do?
eviCore healthcare manages medical benefits by evidence based practices. As with all 3rd party services they handle prior authorizations, claims management and utilization reviews to make sure treatments and procedures are medically necessary and cost effective.
Our goal at eviCore is to accomplish this—keep the standards high and the costs in check. The company collaborates with healthcare providers to facilitate:
Imaging, physical therapy and some procedures need preauthorization.
Checking the claims in order to verify that they’re compliant with medical policies.
Attempting to reduce unnecessary procedures that would overrun the healthcare system.
Why does an insurance company use eviCore?
Insurance companies partner with eviCore for several reasons:
Cost Containment: eviCore helps insurers save money by managing preauthorizations, reducing unnecessary claims.
Improved Care: Evidence based reviews allow patients to receive appropriate sets of treatments.
Efficiency: eviCore’s solutions empower insurance companies to smooth out administrative processing.
eviCore’s What Insurance Companies Use helps Insurance Companies:
eviCore partners with several major insurance companies whose healthcare services they administer. Below is a list of prominent insurers that utilize eviCore’s solutions:
1. Cigna
Preauthorization for advanced imaging, musculoskeletal procedures and radiation therapy is managed by Cigna in collaboration with eviCore. Some medical procedures will require policyholders to get 10viCore’s approval before they can proceed.
2. Aetna
eviCore is used by one of the largest health insurance companies, Aetna, for preauthorization and review of claims, for its Aetna objective of reducing costs associated with unnecessary healthcare in the delivery of quality care.
3. UnitedHealthcare
These specialty healthcare services are overseen by UnitedHealthcare in the areas of radiology, cardiology and oncology and UnitedHealthcare uses eviCore to do so. They are working together to provide efficient and cost effective care.
4. Humana
eviCore expertise is leveraged by Humana in managing benefits related to imaging, musculoskeletal services and therapy. Patients who are covered by Humana are usually confronted by eviCore in the preapproval processes.
5. Blue Cross is referred to as Blue Cross Blue Shield or BCBS in Plans.
A number of regional Blue Cross Blue Shield plans in turn work with eviCore to manage certain medical services. Evicore’s scope of involvement by state and policy type is different.
The effect of eviCore on Policyholders
eviCore’s involvement could mean more steps for policyholders to take before getting some treatments. Here’s what you need to know:
Preauthorization Requirements
Before scheduling specific procedures or treatments, your healthcare provider may require an eviCore preauthorization request before scheduling specific procedures or treatments.
Approval Timelines
Typically, approval occurs within 2 to 3 business days but that may vary depending on case complexity.
Patient Responsibility
In general policyholders need to know if they must seek eviCore approval for any given procedures to ensure there are no delays or excess costs.
Appeals Process
If a patient requests is denied by eviCore, the patient can ultimately appeal the decision through the insurance company or the requestor of the service directly to eviCore.
eviCore For Patients Pros and Cons
Pros:
It is evidence based to ensure treatments used.
It controls overall healthcare costs.
Saves you from unnecessary medical interventions.
Cons:
May delay access to certain procedures.
Administrative extra steps for patients and providers.
An appeal may be required for denials.
eviCore for Policyholder Tips
Understand Your Policy: Read through your insurance plan’s preauthorization guidelines to know the procedures that you will need preauthorization with eviCore.
Communicate with Your Provider: Be sure your healthcare provider is aware of eviCore’s process.
Track Approvals: Follow up on pre authorization request to avoid delayed.
Stay Organized: All communication with your insurance carrier and eviCore, keep on record.
Conclusion
eviCore is essential to modern healthcare, working with insurance companies to bring costs under control while ensuring top notch care. eviCore is used by major insurers such as Cigna, Aetna, Humana, UnitedHealthcare and many Blue Cross Blue Shield plans for medical benefit management.
Whether you are a policyholder or not, knowing exactly how eviCore works can help you make the most of preauthorization requirements and dodge a potential delay. Their (or the collaborative systems’ involvement) may seem like additional complexity, but it (or collaborative systems) really enables a more robust, more efficient, more effective healthcare system.
Knowing that staying informed and being proactive will help you make your insurance benefits work for you, as well as a healthcare experience that is complete.
