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Angioplasty services


As of December 1, 2020, we’ll change our related services claim handling for outpatient cardiac angioplasty services.
 

We require providers to get precertification for non-emergent outpatient diagnostic left and right heart catheterization services. This can be done through our Enhanced Clinical Review program with eviCore healthcare. If you don’t get precertification for the cardiac catheterization, or if the cardiac catheterization is denied by eviCore, then any related angioplasty procedure will also be denied. 
 

Visit eviCore healthcare at eviCore.com for a complete list of procedures that need an authorization. 
 

Asking eviCore healthcare for approval


 Go to eviCore.com.
 

Urgent requests
 

If a member needs services in less than 48 hours due to medically urgent conditions, please call eviCore healthcare for a fast review. Tell them the request is for urgent care.


What you should know
 

  • Be sure that ordering physicians get authorizations and share the approval numbers with the facility performing the procedure when it is scheduled.
  • eviCore healthcare will fax its approval decision to the ordering physicians and requested facilities. 
  • Approvals have authorization numbers and one or more CPT® codes specific to the approved services.
  • If the service you ask for is different from what eviCore healthcare approves, the facility must contact eviCore healthcare for review and approval before submitting claims.
  • If you perform services without approval, we may deny payment. 
  • We will determine coverage under the applicable policy according to the policy’s terms and conditions and our policies and procedures.

Keep in mind
 

  • If the service you ask for is not what eviCore healthcare approves, the facility must contact eviCore healthcare for approval before submitting claims.
  • If you perform services without approval, we may deny payment. 
  • We base our final coverage decision on the applicable policy’s terms and conditions along with our policies and procedures.

We’re here to help
 

If you have questions, call eviCore healthcare at 1-888-693-3211 (TTY: 711). Or you can call Provider Services at:
 

At eviCore.com, you can see their criteria and get request forms.