Peer-to-Peer Scheduling & Reconsideration on the Web
Hi, I’m Mark Tate, and my Provider Experience team is committed to improving your experience with EviCore. In this edition of Ask EviCore, we are sharing two new processes to make your experience faster, better, and more collaborative. You can now schedule your own peer-to-peer consultations through the portal, and for the CareCore National portal, you can also initiate a reconsideration review on the web.
Peer-to-Peer Scheduling Online:
What is a peer-to-peer?
Clinical consultations may also be called a peer-to-peer. A peer-to-peer can be requested once an adverse determination (i.e. denial) is made. A peer-to-peer consultation allows for a clinical discussion between the ordering provider and an EviCore medical director. Many times, additional information is shared during the peer-to-peer conversation to overturn the denial and approve the service based on medical necessity.
On which portal is the online peer-to-peer scheduling process available?
The online peer-to-peer scheduling process is available on both the legacy CareCore National portal and the MedSolutions portal after logging into your portal account via www.EviCore.com. This solution was implemented for the CareCore National portal in June of 2020; and for the MedSolutions portal, this technology became available on June 21, 2021.
Why should I schedule a peer-to-peer review online?
There are many benefits to scheduling a peer-to-peer online:
· You can schedule the discussion at a time that is most convenient for you.
· You can quickly cancel or make a change to a previously scheduled appointment.
· You no longer have to wait for an email confirmation from an EviCore representative when scheduling a peer-to-peer, and instead, can instantly update your calendar.
Will I be able to access a same-specialty physician for a peer-to-peer review?
When scheduling peer-to-peer requests online, you will be provided with a list of physicians who are trained to review the specific case. You are encouraged to select a physician from the list that is provided to you to avoid potential delays with peer-to-peer scheduling. The EviCore system will always provide same-specialty matches when required by the applicable level of review or by state mandate.
How do I know if my case is eligible for a peer-to-peer review? Is there an alternative if it’s not?
If you are unable to request a peer-to-peer review, you will see a pop-up message that displays during the request process. There are some instances where a peer-to-peer review is not permissible, and the case decision cannot be changed. When this happens, a “Consultative Only Peer-to-Peer” review can still be requested, which provides an opportunity to discuss the case, even though the outcome cannot be changed as a result of that conversation. You may also click on the “All Post Decision Options” button to learn what other action may be taken about this specific case.
What if my peer-to-peer request is urgent?
Consistent with the NCQA/URAC definition, EviCore considers an urgent request to be one in which a delay in decision-making may seriously jeopardize the life or health of the patient. If an urgent peer-to-peer is needed, you can contact EviCore by phone to request an urgent appointment. Immediate appointments for an urgent request may not be guaranteed.
How do I cancel or make a change to my scheduled peer-to-peer appointment?
Once you log in, select “My P2P Requests” then select the appointment you would like to modify. Open the request and click the “schedule” link and an appointment window will open. Click on the “Actions” dropdown and select the appropriate action.
Initiate Reconsiderations on the Web:
On which portal can reconsideration requests be initiated?
Reconsideration reviews can be requested online only on the legacy CareCore National portal by logging into your portal account via www.EviCore.com. This new enhancement was implemented May 28, 2021.
What are the benefits of initiating my reconsideration online?
There are several benefits to you when you schedule your reconsideration request online:
· Initiating online streamlines the process and expedites the workflow for a reconsideration decision.
· Online initiation improves the accuracy and timely processing of clinical information for your patient.
· Initiating online saves you and your office staff time.
Does initiating my reconsideration review online change the review process?
No. The reconsideration review process remains unchanged whether you initiate online or via phone.
How can I view my reconsideration options?
All of your reconsideration options, including appeals, are available online. Log in to your portal account via www.EviCore.com, and go to “Authorization Lookup,” then “Enter Information,” then “All Post Decision Options.
What happens if I select ‘No’ to process a standard pre-service reconsideration?
A reconsideration or appeal will not be started.
What if my reconsideration request is urgent? Can I initiate an urgent reconsideration request online?
No, all requests initiated via the web will be processed as a standard request. An expedited request will need to be initiated by phone.
What if I made a mistake or would like to go back to answer a previous question when initiating a reconsideration on the web?
After logging in, you can click on the question you want to amend under “Review History” and change your response.
What information should be submitted with the reconsideration request?
Clinical documentation will need to be uploaded with the reconsideration request on the web. Once the information is uploaded, you will see a message confirming the request has been submitted and the reconsideration determination will be sent via fax. Please note, if there is no clinical documentation uploaded, the request will not move to the reconsideration process and will be cancelled.
How do I sign-up for training to learn more about these portal enhancements?
EviCore will host Provider Forums to review the new enhancements. These forums are free, last approximately one hour, and are offered on different days and times each week. Please register in advance. Whether you are new to the web portal, or are an experienced user with questions, these sessions can help you maximize your web portal experience.
You can view the upcoming schedule andregister for awebinar session here through the following steps:
· Click on the menu on the far left-hand side, just below the EviCore logo, then choose “Webex Training.”
· On the “Live Sessions” screen, click the “Upcoming” tab. In the search box above the tabs, type this exactly as written: Provider Prior Authorization New Enhancement Forum.
· Choose the date and time for the session you would like to attend and click the “Register” link beside that session. You will need to register separately for each session.
· Complete the required information and click the “Register” button.
· Immediately after registering, you will receive an email containing the toll-free phone number, meeting number, conference password, and a link to the web portion of the conference. Please keep the registration email so you will have the web-conference information for the session in which you will be participating.
Do you have additional questions?
· For peer-to-peer questions, please call our Contact Center at (800) 918-8924 (option #1).
· For web portal questions, please call (800) 646-0418, or you may send an email to portal.support@evicore.com.
If you have a question or a topic suggestion for a future edition of theAsk EviCorecolumn, or if you would like to share your feedback about our prior authorization process or this newsletter, email Jackie Jenkins, the National Provider Advocate on my team, atprovidernewsletter@evicore.com. Thanks for your continued partnership and for reading this edition ofAsk EviCore!
