Providers are required to obtain precertification through CareCore National, LLC d/b/a eviCore healthcare (eviCore) for non-emergent outpatient radiation therapy services for all commercial AmeriHealth Pennsylvania HMO and POS members. We use eviCore Radiation Therapy Utilization Management Criteria when reviewing requests for radiation therapy services. For members younger than 19, services requested will be automatically approved; however, precertification through eviCore is still required to ensure accurate and timely claims payment.

NaviNet currently offers direct access to eviCore?s provider portal to streamline the process of obtaining precertification. Providers can select eviCore/CareCore from the Authorizations transaction and a new window will open that sends providers directly to eviCore?s provider portal and allows initiation of the precertification process.

Once on the eviCore provider portal, select the Request a clinical certification/procedure option. Within the Clinical Certification section, providers can identify themselves by using either their National Provider Identifier (NPI) or tax ID number (TIN) and their last name, city, and ZIP code. The search will return any referring provider associated with the information entered. Simply select the appropriate provider/address to proceed with the remainder of the precertification process.

Providers can also initiate precertification for non-emergent outpatient radiation therapy by calling eviCore directly at 1-866-686-2649.

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