We've heard your concerns: We're changing our Medicare Plus BlueSM PPO eviCore requirements for physical therapy
On Jan. 1, 2017, we launched our eviCore physical therapy program with the intent of partnering with our provider community to foster better health outcomes for our members. We introduced this initiative by implementing an evidence-based tool delivered by eviCore that we felt would allow providers to offer their patients appropriate care at the right time.
We expected the program transition to be a seamless and positive experience for our providers. Unfortunately, the affects of this implementation didn't align with our intent. We apologize for any unnecessary confusion, frustration or inconvenience that you may have experienced during this transition. We truly value your partnership and want to assure you that we've heard your concerns and taken them seriously. As such, we've been working with eviCore to identify solutions to address these concerns.
Effective Oct. 1, 2017, we're implementing an interim solution that we hope you'll find satisfactory. When a member has had recent surgery and requires physical therapy as a part of their treatment plan, he or she will be entitled to receive a minimum of 12 visits within 45 days. This approach will allow these members to have two visits per week over the course of six weeks, and gives our providers more time to request approvals for any additional visits they want to have added to a member's treatment plan without creating a lapse in care.
While our interim solution is just a start, we want you to know there are long-term changes on the horizon. We've posted two documents on the e-referral site that detail the changes eviCore is making through the implementation of its new authorization model called corePathSM, effective Jan. 1, 2018:
If you have any questions regarding the information in this message, please reach out to your provider consultant. Thank you for your continued partnership.
Posted: October 2017
Line of business: Blue Cross