Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Stephanie Cole

Healthcare Implementation Manager

Prepared for Physical Therapy Association of Washington

May 11, 2017

Provider Website Overview

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Agenda

• Introduction

• Quick Facts

• Live Demo Benefits

Code checks

Online resources

• Introduce eviCore

• eviCore Website Overview

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Website Overview

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Quick Facts

• Accessing all of our secure tools requires registration through

OneHealthPort (OHP)

• Our website is updated nightly

• Accumulators for physical therapy are available

• You can find the deductible, out-of-pocket and exclusions to the out-

of-pocket on our eligibility and benefits tool

• You can find two years of eligibility, claims and prior authorization

info online

• If the Managed Care Coordinator message appears when you’ve

selected physical therapy or massage therapy from the benefits

dropdown list, that indicates we require evICore review for that

member’s plan

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Online Resources

• Provider orientation and online tool guides premera.com/wa/provider/learning-center

• Eligibility and Benefits: Verify member’s eligibility and benefits,

effective dates and accumulators online.

• Prospective Review Tool: Check a code to see if review is

required. This provides a member specific response.

• Give feedback 24/7 with Premera Listens

• Provider News: Sign up for email alerts to stay up

to date

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

eviCore Website Overview

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

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Case Initiation

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Initiating A Case

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• Choose “request a clinical certification/procedure” to begin a new case request.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Select Program

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Select the Program for your certification.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Service Options

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Select Date Extension, Continuing Care, or Build a New Case.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Select Provider

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Select the Practitioner/Group for whom you want to build a case.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Select Health Plan

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Choose the appropriate Health Plan for the case request.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Select Address

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Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Contact Information

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Enter the Provider name and appropriate

information for the point of contact individual.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Member Information

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Enter the member information including the Patient ID number, date of birth, and patient’s last name. Click “Eligibility Lookup.”

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Clinical Details

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Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Verify Service Selection

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ICD-10 Code

ICD-10 Code

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Site Selection

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Verify all information entered and make any needed changes prior to moving into the clinical collection phase of the prior authorization

process.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Clinical Certification

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You will not have the opportunity to make changes after that point.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Finish Later/Save Option

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Once you have entered the clinical collection phase of the case process, you can save the information and return within (2) business days to

complete.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Medical Review

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If additional information is required, you will have the option to either upload documentation, enter information into the text field, or contact us

via phone.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Medical Review

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Acknowledge the Clinical Certification statements, and hit “Submit Case.”

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Approval

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Once the clinical pathway questions are completed and if the

answers have met the clinical criteria, an

approval will be issued.

Print the screen and store in the patient’s

file.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Building Additional Cases

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Once a case has been submitted for clinical certification, you can return to the Main Menu, resume an in-progress request, or start a new request. You can indicate if any of the previous case information will be needed for

the new request.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Authorization look up

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• Select Search by Authorization Number/NPI. Enter the provider’s NPI and authorization or case number. Select Search.

• You can also search for an authorization by Member Information, and enter the health plan, Provider NPI, patient’s ID number, and patient’s date of birth.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Authorization Status

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The authorization will then be accessible to review. To print authorization correspondence, select View Correspondence.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Eligibility Look Up

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Premera is an Independent Licensee of the Blue Cross Blue Shield Association

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Provider Resources

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Musculoskeletal Online Resources

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Clinical Guidelines, FAQ’s, Online Forms, and other important resources can be accessed at www.evicore.com. Click “Solutions” from the menu bar, and select the specific program needed.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

eviCore Provider Blog Series

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• The eviCore blog series focuses on making processes more efficient and easier to understand by providing helpful tips on how to navigate prior authorizations, avoid peer-to-peer phone calls, and utilize our clinical guidelines.

• You can access the blog publications from the Media tab or via the direct link at https://www.evicore.com/pages/media.aspx.

Premera is an Independent Licensee of the Blue Cross Blue Shield Association

Web Portal Services-Assistance

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Email portal.support@evicore.com

Call a Web Support Specialist at (800) 646-0418

(Option 2)

Connect with us via Live Chat

Web Portal Services-Available 24/7