Provider news

Update: New auth process for ortho surgeries, genetic testing, advanced imaging coming mid-June

This news article was originally posted in March. It has been updated with the new timeframe.

Our Auth Request tool will soon take providers to either Clear Coverage™ or to eviCore healthcare, depending on the type of auth you're requesting.

eviCore is already working with thousands of Michigan providers on authorization services, but they will be taking on new services for Priority Health members.

This new functionality was originally scheduled for May 25, but we have found some things that need to be changed/streamlined before we can ask you to use eviCore through the Auth Request tool. We expect it to be available starting June 19.

Services authorized by eviCore

eviCore follows evidence-based guidelines that are clear, and they have medical directors that are specialty-specific to engage in meaningful peer-to-peer discussion. You'll work directly with eviCore to request prior authorization for the following services:

  • All musculoskeletal procedures, such as surgeries or arthroscopies for hips, knees and shoulders
  • Spinal procedures, including open, percutaneous and endoscopic interventions, like fusions and laminectomies
  • Genetic testing
  • Advanced diagnostic imaging (authorizations will move from AIM to eviCore)

For services that require authorization, providers are liable for the cost if the service is performed without authorization.

How to request eviCore authorizations

We'll be adding information about accessing eviCore authorizations to the Provider Manual. You'll have multiple ways to request authorizations:

  • Online: Log in to your Priority Health provider account and click Auth Request in the provider tools menu
  • Phone (coming soon): Call eviCore direct at 844.303.8456
  • Fax radiology/spine/joint auth requests: 800.540.2406; lab: 844.545.9213

Eligible plans

Authorization for the services listed above will be required by all Priority Health plans: Commercial group and individual plans, Medicare and Medicaid.

Register for a one-hour online training webinar

eviCore will be mailing a letter on May 20 to providers who have billed for the codes that will require authorization through eviCore. The letter includes an invitation to training webinars. You can also visit evicore.com/healthplan/priorityhealth to find clinical guidelines, FAQs, and a list of CPT codes that require authorization.

Registration form

Go to eviCore to register, then look for the link to the Priority Health Provider Orientation Invitation.

Training webinar schedule

All times Eastern.

Spine and joint auth requests:

  • Thursday, June 1, 1 p.m.
  • Thursday, June 8, 9 a.m.
  • Tuesday, June 13, 11 a.m.
  • Thursday, June 22, 1 p.m.

Radiology auth requests:

  • Thursday, June 1, 9 a.m.
  • Thursday, June 8, 11 a.m.
  • Tuesday, June 13, 1 p.m.
  • Thursday, June 22, 9 a.m.

Lab services auth requests:

  • Thursday, June 1, 11 a.m.
  • Thursday, June 8, 1 p.m.
  • Tuesday, June 13, 9 a.m.
  • Thursday, June 22, 11 a.m.

Our goal is to work more closely with you, our provider partners, to optimize health outcomes while providing evidence-based, value-driven care. The evidence is clear that focusing on appropriate care impacts all aspects of the triple aim: quality care and outcomes, satisfaction and improved cost.

Category: Authorizations