More procedures to be reviewed by eviCore healthcare effective September 1

Effective with dates of service on or after Sept. 1, 2015, additional non-emergent outpatient high-tech radiology services and also many cardiology and radiation therapy services must undergo clinical review by eviCore healthcare (formerly CareCore National). These requirements will apply to BCN HMOSM (commercial) and BCN AdvantageSM members.

Providers will be able to submit requests for clinical review for these procedures in one of two ways:

The requests must be reviewed prior to the services being rendered. If a treating physician does not receive a medical necessity determination and authorization number from eviCore prior to performing procedures for which eviCore's review is required, claims may not be reimbursed.

Currently, review by eviCore is required for certain outpatient CT, MRI and nuclear scans. Prior to the effective date of the new requirements, an updated outpatient high-tech radiology procedure code summary, listing all the radiology procedures reviewed by eviCore, will be available on the Radiology Management Program page on this website. In addition, lists of all the cardiology and radiation therapy procedures reviewed by eviCore will also be available on that page.

The additional radiology procedures that will require eviCore's review include but are not limited to the following:

Radiology

The cardiology and radiation therapy procedures that will require eviCore's review include but are not limited to the following:

Cardiology

Radiation therapy