Blue Care Network contracts with eviCore healthcare® to provide utilization management for the following services:
- Outpatient physical, occupational and speech therapy services for BCN commercial and BCN AdvantageSM members delivered by independent physical therapists, outpatient therapy providers, physician practices and hospital-based outpatient therapy services
- Physical medicine services provided for BCN commercial members by chiropractors (starting May 27, 2019) and by athletic trainers (for dates of service on or after Jan. 1, 2021)
Authorization requests for both initial and follow-up visits should be submitted to eviCore in one of these ways:
- By clicking the Authorizations and Referrals button for the member on the web-DENIS Eligibility/Coverage screen
- Through the eviCore healthcare provider portal at www.evicore.com*
- By calling eviCore at 1-855-774-1317, preferably prior to providing services
For additional information on the utilization management requirements for these services, refer to the Utilization Management chapter of the BCN Provider Manual. Look in the section titled "Managing PT, OT and ST / Managing physical medicine services."
These utilization management requirements don’t apply to BCN 65 members or to the treatment of autism spectrum disorders for members 18 years of age and younger.
Resources for managing therapy and physical medicine services
- Outpatient rehabilitation services: Frequently asked questions (PDF)
- BCN implementation page on the eviCore website*
- Understanding your BCN coverage for different therapy / physical medicine services (PDF)
- Tips about eviCore Authorizations for BCN Members (PDF)
- Suggestions for the Efficient Utilization of Therapy and Physical Medicine Services (PDF)
- Tips for improving treatment efficiency (PDF)
- FAQs: Practitioner Performance Summary and Provider Categories* (PDF)
- Chiropractic services: For chiropractic manipulations and physical medicine services by chiropractors (PDF) - Includes information about utilization management programs
- Outpatient PT, OT and ST, and physical medicine services by chiropractors and athletic trainers: For authorization determinations (PDF)
- U-M Premier Care Primary (Major) Diagnosis Codes for Therapies (PDF)
See also BCN's eviCore-Managed Procedures page on this website.
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