Carecore National Auth Lookup (2024)

FAQs

Is eviCore and CareCore the same? ›

CareCore | MedSolutions is now eviCore healthcare. Please note that there will be no changes to how prior authorizations are submitted or your overall user experience as a result of this rebranding effort.

A process by which EviCore makes an evidence-based determination regarding whether a particular requested healthcare service or supply should be covered under a Member's healthcare benefits coverage (which may include, among other items, Medical Necessity determinations).

Retrospective requests for authorization, not related to urgent procedures, will be accepted up to 180 calendar days following the treatment start date and prior to the submission of the claim. Please have all clinical information relevant to your request available when you contact eviCore healthcare.

CareCore National, LLC, doing business as eviCore healthcare, provides managed healthcare services. The Company offers radiology, radiation therapy, cardiology, medical oncology, lab management, and health plan, as well as other specialty solutions. eviCore healthcare serves customers in the United States.

The estimated total pay range for a clinical reviewer at eviCore healthcare is $80K–$132K per year, which includes base salary and additional pay.

eviCore is a leading benefit management company, formed through the merger of CareCore National and MedSolutions in 2014.

Prior authorization—sometimes called preauthorization or precertification—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affiliates.

Prior authorization requests can be denied or delayed because of seemingly mundane mistakes. A simple mistake could be having the request submitted for a patient named John Appleseed when the health plan member's health insurance card lists the member's name as Jonathan Q.

What happens if prior authorization is not obtained? ›

If prior authorization is required and is not obtained, the health plan can reject the claim—even if the procedure was medically necessary and would otherwise have been covered.

When prior authorization is granted, it is typically for a specific length of time. You will need to request prior authorization again if you need a refill after the timeframe passes. If you don't get approval, you may be responsible for the cost of the medication, but you can appeal the decision.

The Company was formed by the transformative merger of MedSolutions, TA's original investment, with CareCore National, which together rebranded as eviCore healthcare in 2015.

In order to determine the appropriate portal to use to submit your prior authorization, we have made it easy for you. Simply visit the EviCore's Provider's Hub page and select the health plan and solution option for your case in the training section.

The talents, technologies and tactical expertise of CareCore | MedSolutions are now unified as EviCore healthcare (EviCore). The recently merged companies combined to deliver innovative MBM solutions designed to bring better outcomes to everyone involved in the healthcare system: patients, providers and payers alike.

ST. LOUIS, MO and BLUFFTON, SC (October 10, 2017) -- Express Scripts Holding Company (NASDAQ: ESRX) today announced that it has reached an agreement to acquire privately-held EviCore healthcare, the industry leader in evidence-based medical benefit management services, for $3.6 billion.

EviCore is the recognized industry leader in medical benefits management, with more than 25 years of experience covering 100 million lives.

Aetna has contracted with eviCore healthcare, an independent specialty medical benefits management company, to administer prior authorization for Enhanced Clinical Review program.