Blue Cross Blue Shield of North Dakota (BCBSND) partnered with eviCore Healthcare (eviCore) to provide benefits management for molecular and genomic testing under eviCore’s laboratory management program. BCBSND wants to remind providers they are required to submit precertification requests for molecular and genomic testing through eviCore for dates of service January 1, 2020, and after.
The Federal Employee Program (FEP) and claims where BCBSND is secondary is excluded from this process.
eviCore’s laboratory management clinical guidelines, along with a listing of the molecular and genomic testing CPT codes is posted to eviCore’s resource site www.bcbsnd.com/evicore under the Solution Resources tab. Clinical guidelines and CPT codes are identified as those that require prior authorization or those where claims policies are applied.
Frequently Asked Questions (FAQ):
Q: How do I request a precertification?
A: Log onto www.evicore.com/pages/ProviderLogin.aspx OR call eviCore at 1-800-228-6386.
Q: Where do we locate the list of CPT codes?
A: Access www.bcbsnd.com/evicore, under the Solution Resource tab and choose Laboratory Management Module.
Q: Who do I call if I have more questions?
A: Call eviCore’s Client and Provider Services department at 1-800-646-0418.
Q: What procedures require precertification through eviCore?
A: Most molecular and genomic tests require precertification through eviCore. Providers are referred to the BCBSND eviCore website at the following link: www.bcbsnd.com/evicore. Here they will find the list of CPT/HCPCS codes that require precertification and those that are subject to claims policy, along with BCBSND’s eviCore adopted medical and reimbursement guidelines and Provider FAQ document.
Q: What if a test is completed, but I then realize the CPT requires precertification, what should I do?
A: If the test performed required precertification, which was not received before the test was completed, the claim will deny. Providers should contact eviCore and submit a precertification request. eviCore will then review the request for medical necessity and appropriateness.
If the test performed did not require a precertification, you can formally request an appeal with BCBSND.
Q: Once I have an approved precertification from eviCore, will my claim be reprocessed?
A: If the precertification is done after the claim already rejected, submit a frequency 8 to void the rejected claim and submit new claim for processing.