Skip Ribbon Commands
Skip to main content
Home Administrative Billing & Reimbursement BlueCard® Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Obtaining precertification for non-emergent radiation therapy services through NaviNet®

July 2, 2015

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 and Medicare Advantage HMO, POS, and PPO 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.

CareCore changes name to eviCore

In June, as a result of their recent merger with MedSolutions, CareCore National, LLC, launched a new name and brand: eviCore healthcare (eviCore). We will work as quickly as possible to revise provider resources, including NaviNet, the Medical Policy Portal, and our manuals, to reflect this new name. All phone numbers and contact information will remain the same for eviCore.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
Connect with us     Facebook     Twitter     Flickr     YouTube     Walk the Talk    Independence Pinterest    Independence LinkedIn    Independence Instagram Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer
© 2023 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.