eviCore Provides Utilization Management for Cardiology Imaging, Radiology, and Radiation Therapy for AdvantageCare Physicians

Date Issued: 6/27/2018

Utilization Management for ACPNY Members

eviCore, as of January 1, 2018, now performs utilization management (prior approval) for ACPNY radiology services. All Health Insurance Plan of Greater New York (HIP) members with an ACPNY primary care physician now require a prior approval; the referring provider will need to contact eviCore to get the prior approval. EmblemHealth will continue to process claims for radiology services.

Requesting Prior Approval

Web submissions are the quickest and most convenient way to request prior approval. Please visit eviCore to access their web portals. Prior approval can also be obtained over the phone by calling eviCore at 866-417-2345.

Outpatient Radiology Services Performed by Cardiologists

Cardiologists that provide radiology services will continue to be contracted directly with – and be reimbursed by – EmblemHealth.

For additional information on obtaining prior approval for radiology services, please refer to the Cardiology Imaging Program, Radiation Therapy and Radiology Program chapters of the Provider Manual.