eviCore has updated corePath for physical and occupational therapy authorizations

Effective immediately, eviCore healthcare^® has made changes to the corePath^SM therapy authorization model for first authorization requests for new episodes of treatment. This change applies to:

• Physical therapy providers in categories B and C
• Occupational therapists in category B

Here's what changed

For providers in categories B and C: When initial authorization requests meet certain conditions, eviCore is approving a greater number of visits over a longer authorization duration period. The logic in eviCore's corePath model determines the number of visits and authorization duration based on the patient's condition and complexity.

For more information about how this affects occupational therapy providers, see eviCore's Physical Therapy Practitioner Performance Summary and Provider Category FAQs (PDF) document.* See the question titled "How does my category impact my authorization requirements for occupational therapy?"

Note: There haven't been any changes to the number of visits granted or the authorization duration period for providers in category A.

Additional information

You can find information about this change in the June 2020 issue of eviCore's provider newsletter.

To learn more about category assignments, see eviCore's Physical Therapy Practitioner Performance Summary and Provider Category FAQs (PDF) document.*

You can find additional information on this website:

• On BCN's Outpatient PT, OT, ST page
• On the Blue Cross eviCore-Managed Procedures page. Look in the "Medicare Plus Blue PPO members" section.

As a reminder, eviCore manages physical therapy and occupational therapy services for non-autism diagnoses for Medicare Plus Blue^SM PPO, BCN HMO^SM (commercial) and BCN Advantage^SM members. eviCore also manages physical therapy and occupational therapy services for adult BCN HMO members ages 19 and older with autism diagnoses.

*Clicking this link means that you're leaving the Blue Cross Blue Shield of Michigan and Blue Care Network website. While we recommend this site, we're required to let you know we're not responsible for its content.

Posted: June 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network