New updates and enhancements to Auth Request tool
eviCore authorizations now available online
Priority Health has partnered with eviCore healthcare to assist us with the prior authorization of certain high-cost, high-utilization procedures. As of June 19, 2017 eviCore replaces AIM for high-tech radiology authorizations. You can also request authorizations for musculoskeletal, spine and joint procedures such as arthroscopies, and for genetic testing.
You can request authorizations through eviCore by using the Auth Request tool in your provider tools menu. Auth Request will send you to either Clear Coverage™ or eviCore, depending on the procedure you're requesting.
Clear Coverage updates
Since the successful go-live of Clear Coverage™, we've made a few enhancements and updates.
Spine or joint procedures
When you admit a patient and input an authorization through Clear Coverage™ for a spine or joint procedure, choose "EVICORE" as the unit option. This will allow you to bypass admission criteria and admit the patient.
Continued stay reviews
Now required every 4 days for commercial group and individual plan patients, and every 5 days for Medicare and Medicaid patients. It previously was every 2 days.
Continued stay reviews are to be submitted on the day they are due and NOT before, as this causes issues with submission of reviews.
Elective OB admissions
The requirements for these types of admissions have been adjusted to allow you to enter an admission without needing to step through InterQual Criteria.
Modification of admission dates
We've added the ability to modify admission dates for elective admissions. Simply click the "Modify Request" button to change the admission date.
To learn more about requesting authorizations with Clear Coverage™ or eviCore, visit the Provider Manual Authorizations page.