Priority Health is making changes to their eviCore prior authorization program based upon your feedback to better serve you while ensuring our members are getting high quality, cost effective care.
Starting on Sept. 5, a subset of the high-tech radiology CPT codes will stop auto approving and will require authorization.
Some requests may pend for additional information. Once the information is received a decision will be made within two (2) business days.
These codes will be subject to denials. You'll have the option to request peer-to-peer review for services to commercial and Medicaid members within 14 days from the date of denial.
The remainder of the high-tech radiology CPT codes will remain on auto approval.
What's not changing
Musculoskeletal procedures will remain on auto approval until we've finalized an improved process.
Genetic testing remains on prior authorization.
You should continue to request authorizations through eviCore in the same method you have been. As a reminder, urgent authorizations should be handled by calling 844-303-8456, not the website.
Enhancements you'll experience with the relaunch include:
More real-time results as a result of your concerns about the number of cases pending without the ability to enter in relevant data.
Easier data entries with new features like a back button, duplicate option, and save/finish later choices.
Reduced "provider and member not found" messages.
Live training options, including on-site visits and webinars from eviCore.
Less waiting, better specialty matching and more reliable access to eviCore clinicians for peer reviews. To request a consultation with a medical director online: evicore.com/healthplan/priorityhealth
Shorter hold times when calling eviCore as a result of more eviCore customer service and nursing staff.
Removal of delays or denials based on contrast rules.