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Effective July 1, 2016, AmeriHealth will implement a new utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic tests for all commercial AmeriHealth members. AmeriHealth is working with CareCore National, LLC d/b/a eviCore healthcare (eviCore) to manage precertification and/or prepayment reviews.
This utilization management program will encompass precertification and/or prepayment review as follows:
- Precertification will be required for certain genetic/genomic tests.
- All genetic/genomic tests, along with certain molecular analyses and cytogenetic tests, will be reviewed prior to claim payment.
Submitting requests to eviCore
Starting June 27, 2016, you can request precertification for genetic/genomic tests for dates of service on or after July 1, 2016, by calling eviCore directly at 1-866-686-2649 or submitting requests via the NaviNet® web portal.
To submit a request on NaviNet, select CareCore from the Authorizations option in the Workflows menu, and a new window will open that sends providers directly to eviCore's provider portal to initiate the precertification process. Once on eviCore's portal, you will be required to create a login and password, which will be used every time you request precertification through eviCore. If you have already established credentials for eviCore's portal, please use your current login information.
Tutorial webinars
To assist you in using their provider portal, eviCore will host the following tutorial webinars called "AmeriHealth Laboratory Management Program Provider Orientation Session":
- June 21, 2016, 12 ? 1 p.m.
- June 23, 2016, 1 ? 2 p.m.
If you are interested in participating, visit
eviCore's WebEx page, select the
Training Center tab, and then choose your preferred session from the
Upcoming tab. If you have any questions about signing up for these training sessions, please
email us.
More information
For more information on the new utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic tests, please refer to the May 2016 article, Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic tests.
If you have questions about this program, you can contact your Provider Partnership Associate or Network Coordinator or call Customer Service at 1-888-YOUR-AH1 (1-888-968-7241) for AmeriHealth New Jersey or at 1-800-275-2583 for AmeriHealth Pennsylvania.
NaviNet is a registered trademark of NaviNet, Inc.
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