High Tech Imaging and Ultrasound FAQs

This list reflects answers to frequently asked questions regarding high tech imaging and ultrasound services.

  • 1. Who is eviCore healthcare?

    MedSolutions, a leading provider of Medical Benefits Management (MBM) services to managed care organizations and risk-bearing provider organizations, is pleased to announce its launch of a rebranding and re-naming initiative that will further advance the company's commitment to contain healthcare costs and help achieve quality outcomes.

    MedSolutions is now eviCore healthcare.
     

  • 2. How do I get more information on eviCore for High Tech Imaging and Ultrasound?

    Visit eviCore's website to learn more. Log into the provider portal for more resources.

    eviCore Representatives - Personal On-Site Visit Requests

    NC Medicaid high tech imaging and ultrasound providers who wish to request a personal on-site visit by eviCore’s representatives may do so by calling 800-575-4517, Option 3.

  • 3. How do I submit a High Tech Imaging and/or Ultrasound PA?

    There are three ways to submit a request to eviCore for outpatient diagnostic imaging procedures.

    1. Submit requests through eviCore’s secure website: https://www.evicore.com/
    2. Contact eviCore via phone at 1-888-693-3211 weekdays between 8am and 9pm EST.
    3. Submit requests via fax at 1-888-693-3210.

  • 4. How do I know what CPT codes need a PA?

    For a complete list of high tech imaging procedures and ultrasounds that require prior authorization from eviCore, please refer to the North Carolina Medicaid Prior Approval for Imaging Policy 1K-7 which can be found on the North Carolina Radiology clinical coverage Policy web page. Claims for high tech imaging and ultrasound services submitted without an eviCore authorization will deny for no high tech imaging or ultrasound PA on file.

  • 5. What is NC Medicaid's Authorization-to-Claim Match Criteria?

    NCTracks has claim adjudication edits in place to ensure the claim line has the proper eviCore prior authorization on file in order to pay. NC Medicaid’s Authorization-to-Claim matching edits are as follows:

    1. For high tech imaging services (other than ultrasounds), the CPT code on the claim must match the CPT code on the eviCore approved authorization.
    2. For ultrasound services, the CPT code(s) on the claim must match the CPT code(s) that is approved on the eviCore authorization.
    3. eviCore authorization’s for high tech imaging or ultrasounds are valid for 30 days. The dates of service on the claim must fall within the authorized period.
    4. The billing/rendering provider NPI on the claim must match the eviCore authorization.

  • 6. What if a lower or higher intensity code was performed than what was authorized on the eviCore PA?

    1. A provider can bill a “lesser intensity” procedure code from the same contrast family for CT’s, MRI’s, or MRA’s than what was approved by eviCore. Please refer to North Carolina Medicaid’s Prior Approval for Imaging Policy 1K-7 attachment B, for a list of lesser intensity codes that can be billed with a higher intensity authorization.
    2. If an authorization is obtained for a lesser CPT code, within the same family, than what you will bill on the claim, you will need to contact eviCore to request the CPT code change prior to submitting the claim. 
    3. OB Ultrasounds and Diagnostic Ultrasounds must have an exact authorization-to-claim match for the CPT code.

     

  • 7. Can a request for an NC Medicaid authorization be made after the high-tech imaging and non-OB ultrasound service is done?

    Requests made after service performance (retrospective requests) will be permitted only in cases where imaging is clinically urgent based on NCQA guidelines for high tech imaging and diagnostic ultrasounds.

     

    Retrospective requests for cases that are clinically urgent can be submitted up to and including two business days after the service was performed for high tech imaging and ultrasounds. The ordering physician shall call eviCore at 888-693-3211, or you may fax the request using the NC DHB fax form to 888-693-3210 with the required medical information. Authorizations on retrospective requests are valid for the date of service only. Requests will be denied that are submitted beyond the established time limit, or if medical necessity and clinical urgency are not met.

     

    Providers should not submit the claim until they have received approval of the retrospective request.

  • 8. What do I do if I cannot find the NPI of the Rendering Facility or IOP (In Office Procedure) Provider shown on eviCore's web page when I am requesting the NC Medicaid authorization?

    Providers who cannot find the rendering facility NPI and address that is needed for an authorization should contact eviCore Client Services Department at 1-800-575-4517 option 3 for assistance.

  • 9. What is Accuracy Assessment for on-site imaging?

    Providers that perform imaging in their office (In Office Providers) are required to complete an assessment with eviCore prior to rendering services in their office. You can begin the Accuracy Assessment process by going to www.accuracymgmt.com and requesting a log-in for the assessment of your location.

     

    Note: If you are an Accuracy Assessed provider and your address or NPI is changed for any reason; you should immediately notify eviCore’s Client Services at 1-800-575-4517, option 3, to ensure there is no delay with your NPI and address being available for authorization requests.