Aetna Better Health Premier - EVICORE Authorization and Appeal Guidelines

July 22, 2019

Aetna Better Health  has recently provided the following informaiton:

Please review the information below regarding EVICORE authorizations and appeal guidelines.

 

Medical Prior Authorizations:   

Note:  If a claim denies not authorized, providers must request an authorization before submitting a provider appeal.  If the retro authorization request is denied, a provider appeal can be submitted to the health plan.

 

High Tech Radiology Authorizations

MedSolutions/EviCore:

  • Phone: 1-888-693-3211
  • Client & Provider Opertions team at 800-575-4517 or email clientservices@evicore.com.
  • Prior Authorization Denials- Please use the Request Form on EVICORE’s website to submit additional clinical information that justifies the medical necessity of a denied case. 
  • Retro Authorization requests to EVIROE
  1. Can be submitted at any time
  2. Requests submitted beyond 90 calendar days from the DOS will be admin denied
  3. Turn around time: 14 calendar days

                

  • Grievance and Appeals is handled by the Health Plan:           
  • Fax: 1-860-975-3615
  • Mail: Aetna Better Health of Michigan, Grievance & Appeal Manager, 1333 Gratiot Ave, Suite 400, Detroit, MI 48207

 

Also included  the provider presentation found on the eviCore ABH MI provider site – at:  https://www.evicore.com/implementation/healthplan/aetna-better-health/michiganABH