New effective date for eviCore healthcare expanded reviews is Oct. 1, 2015
October 1, 2015, is the new effective date on which eviCore healthcare (formerly CareCore National) will perform clinical review for additional radiology services and for select cardiology and radiation therapy services.
This applies to select non-emergent outpatient services when performed on or after Oct. 1, 2015, in freestanding diagnostic facilities, outpatient hospital settings, ambulatory surgery centers and physician offices for BCN HMOSM (commercial) and BCN AdvantageSM members.
The date previously announced for the start of the expanded reviews was Sept. 1, 2015.
If a treating physician does not receive a medical necessity determination and authorization number from eviCore prior to performing these procedures, claims may not be reimbursed.
Requests for clinical review can be submitted in one of two ways:
- Preferred method: online at www.evicore.com
- By phone at 1-855-774-1317
A full list of procedures that require clinical review on or after Oct. 1, 2015, will be available by the end of September on the Radiology Management Program page on this website.