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New Prior Authorization Requirements for Cardiology and Radiology Advanced Imaging

Posted on 2024-05-21 | Updated on 2024-06-11 15:17:21

CareFirst Partnering with EviCore for UM Services for Cardiology and Radiology Imaging

CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively, “CareFirst”) is continually working with healthcare delivery partners to optimize care management strategies while ensuring members receive affordable, quality care.

CareFirst and EviCore are collaborating to provide services for CareFirst members enrolled in our fully insured commercial plans for Cardiology and Radiology Advanced Imaging. EviCore leverages clinical expertise, evidence-based guidelines, and innovative technologies to deliver best-in-class medical benefit management solutions that inform more effective, affordable treatment and site of care decisions for each patient’s needs.

What's Changing?

Effective July 22, 2024, ordering providers will need to submit a prior authorization for outpatient services to EviCore for these members for dates of service beginning July 22, 2024. Providers will be able to enter and submit authorizations up to five days prior, starting July 15, 2024, for dates of service beginning July 22, 2024.

Services performed without authorization may not be reimbursed for healthcare services, and providers may not seek reimbursement from members. Additional information on the specific services that will require authorization will soon be available on our provider website under Programs/Services > Pre-Cert/Pre-Auth (In Network). Here is a direct link to that page: Pre-Cert/Pre-Auth (In-Network) (carefirst.com)

Note: FEHBP members are not included in these requirements.

How will I request prior authorization?

• From our provider website, log into the CareFirst Provider Portal (CareFirst Direct).
• Select the Prior Auth/Notification tab.
• Select Start Now within the Advanced Imaging for Cardiology and Radiology box to be transferred to EviCore’s Prior Authorization Portal (CareCore National Portal).

Will training be available?

To help familiarize you with these changes, we have scheduled several live webinars in July for you to attend. To register, you can select the ‘Register Now’ link for the date/time that works best for you.

 

 

Registration links are also available on our Webinars page on the Learning and Engagement Center.

Be on the lookout for additional information as we get closer to implementing these new requirements. Thank you for your continued support of CareFirst members.