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Save Time by Using the eviCore Web Portal for Benefit Preauthorization Requests

Posted April 25, 2019

Blue Cross and Blue Shield of Illinois (BCBSIL) contracts with eviCore healthcare (eviCore), an independent specialty medical benefits management company, for select outpatient utilization management services for some of our PPO members.

When benefit preauthorization through eviCore is required, there are many advantages to submitting your request electronically through eviCore’s provider portal. eviCore recently made several improvements to make requests even easier. (Note: Benefit preauthorization through BCBSIL will continue to be required for other services/care categories. For benefit preauthorization through BCBSIL, we encourage you to use our online tool, iExchange®.)

Submitting a request through the eviCore provider portal helps make sure the request is submitted correctly and includes the needed information, which will help smooth the approval process. Using the eviCore provider portal to submit benefit preauthorization requests will also allow you to:

  • Review clinical criteria – Review guidelines to see what’s required, prior to submitting your request.
  • Save time – Online benefit preauthorization requests are three times faster than phone requests.
  • Access requests 24/7 Submit requests and check their progress when it’s most convenient for you.
  • Stop and start as needed – Save your benefit preauthorization request and return to it later, without the need to start over.
  • View and print results – See case numbers and approval details online.
  • Check which procedure codes/diagnoses are impacted – See codes for applicable categories/members.
  • Upload members’ medical records – Use the portal to respond quickly with clinical information necessary to support medical necessity of the service/procedure.
  • Schedule consultations online – Set up a Clinical Consultation through the portal if you have questions.

To begin submitting benefit preauthorization requests online, go to eviCore.com and register. Training sessions are available through the eviCore training center. For provider portal help, email portal.support@evicore.com or call 800-646-0418 and select option 2.

Important Reminder: Always Check Eligibility and Benefits First 
Benefits will vary based on the service being rendered and individual and group policy elections. It’s critical to check eligibility and benefits for each patient to confirm coverage details. This step will also identify benefit preauthorization/pre-notification requirements and specify utilization management vendors that must be used, if applicable. Submit online eligibility and benefits requests (electronic 270 transactions) via the Availity® Provider Portal or your preferred web vendor portal.

Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.

eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. iExchange is a trademark of Medecision, Inc. (Medecision), a separate company that provides collaborative health care management solutions for payers and providers. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third-party vendors such as eviCore, Availity or Medecision. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.