NEW! eviCore healthcare (eviCore)

eviCore healthcare (eviCore) is an independent, specialty medical benefits-management company that provides utilization management services for Martin’s Point Health Care.

eviCore manages authorizations for the following radiology and cardiology services for our Generations Advantage members.

  • Advanced Imaging (CT, MR, PET)
  • Myocardial Perfusion Imaging (Nuclear Stress)
  • Echo
  • Echo Stress
  • Cardiac Imaging (CT, MR, PET)
  • Ultrasound (non-OB)
  • Nuclear Medicine

The quickest, most efficient way to obtain prior authorization for any of these services is through eviCore’s 24/7 self-service web portal at www.eviCore.com/healthplan/Martins_Point.

Prior authorization can also be obtained via phone at 1-888-693-3211 or fax at 1-888-693-3210. Their call center is available at 1-888-693-3211 from 7 am–8 pm, ET, Monday through Friday.
The following information must be submitted to eviCore in order to receive a medical-necessity determination:

  • Procedure requested
  • Patient, ordering provider, and rendering site information
  • Prior/ongoing treatments and their effects
  • Current clinical condition and recent test results

Timely Notifications of Urgent Admissions
Admitting providers please be sure to notify the Martin’s Point Health Management department of all urgent hospital admissions within 24 hours of admission (or next business day, if after hours or on weekends). Failure to notify in a timely manner may result in denial of payment for services provided.

Skilled Nursing vs. Swing Bed Admissions
Members/providers requesting skilled nursing services at a swing bed level of care must meet the following medical-necessity criteria.

  • The facility is certified as a Critical Access Hospital by CMS under §485.606(b); and the facility provides not more than 25 inpatient beds; and the number of beds used at any time for acute-care inpatient services does not exceed 15 beds. Any bed of a unit of the facility that is licensed as a distinct-part SNF at the time the facility applies to the State for designation as a CAH is not counted under this section.
  • Facilities must submit a prior authorization request.
  • Three-day inpatient stay is required prior to request of swing bed services. Patient must have complex medical needs that are documented in the medical record plus indication of why needs can’t be met at a skilled nursing facility.
  • Documentation that there are no open skilled nursing facility beds available or willing to take member within 50 miles of discharging hospital.