HealthCare News

eviCore healthcare Partnership for Molecular and Genomic Testing

Issue: #411 NOV2019

Topic: Education


As announced on October 18, Blue Cross Blue Shield of North Dakota (BCBSND) has partnered with eviCore healthcare to provide benefits management for molecular and genomic testing under eviCore’s laboratory management program. Beginning December 13, 2019, providers will submit precertification requests through eviCore healthcare for dates of service January 1, 2020 and thereafter. The Federal Employee Program is excluded from this process.

eviCore healthcare’s laboratory management clinical guidelines, along with a listing of the molecular and genomic testing CPT codes is posted to eviCore’s resource site (www.bcbsnd.com/evicore) under the “Solution Resources” tab. Clinical guidelines and CPT codes are identified as those that require prior authorization or those where claims policies are applied. Approximately 230 molecular and genomic testing CPT codes will require precertification. Services performed without precertification may not be reimbursed for these molecular and genomic tests and providers may not seek reimbursement from members. Services performed in conjunction with an inpatient or observation stay, or emergency room visit are not subject to precertification requirements. For those codes denoted as having claims policies apply, BCBSND will be providing a claim edits grace period until February 28, 2020.

Precertifications contain approval numbers and one or more CPT codes specific to the services authorized. If the service performed is different than what was initially authorized, the rendering facility must contact eviCore to make revisions to the precertification prior to claim submission.

To request a precertification:

For urgent requests

If services are required in less than 72 hours due to medically urgent conditions, you may indicate this during your online submission, or you may call eviCore’s toll-free number for expedited precertification reviews. Be sure to tell the eviCore representative the precertification is for medically urgent care.

Training sessions

Next month, eviCore healthcare is leading orientation sessions designed to assist you and your staff with the new utilization management program. Please attend the web training session that works best for you and your schedule.

During these sessions eviCore will discuss in detail the precertification requirements for Laboratory Management services for molecular and genomic testing and how to navigate the eviCore website at www.evicore.com. Time and participation permitting, a Q&A session will follow each session. We encourage you to attend one of these informative sessions to ensure your understanding of the precertification process for Laboratory Management services.

Registration

All online orientation sessions require advance registration. Each online orientation session will last approximately one hour. All sessions are scheduled in Central Standard Time (CST).

Day of the Week

Date

Time

Tuesday

December 10

4 p.m.

Wednesday

December 11

11 a.m.

Thursday

December 12

9 a.m.

Tuesday

December 17

10 a.m.

Wednesday

December 18

1 p.m.

Thursday

December 19

3 p.m.

How to Register

Please read the following instructions to register for and participate in a session:

  1. Please go to eviCore’s Webex Training website by clicking here.
  2. Type in “Blue Cross Blue Shield of North Dakota” in the search bar.
  3. Click “Register” next to the session you wish to attend.
  4. Enter the registration information.

After you have registered for the training, you will receive an email containing the toll-free phone number and meeting number, conference password and a link to the web portion of the session. Please keep the registration email so you can reference the link to the Web conference and the call-in number for the session in which you will be participating.

If you are unable to participate in a session, you can obtain a copy of the presentation as well as other important documents at www.bcbsnd.com/evicore. Documents are available in PDF format. If you need Adobe Reader, you can download it from www.adobe.com/products/reader/. The session will also be recorded.

If you have any questions regarding the eviCore web portal, please contact the eviCore Web Support team via email at portal.support@evicore.com or via phone at 800.646.0418 (Option 2).