Tag: eviCore
HealthSpring Change in Prior Auths
Change in prior authorization administration for DME services, effective March 1, 2026 |
Effective March 1, 2026, HealthSpring will manage prior authorizations for durable medical equipment services, as well as orthotic and prosthetic codes. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.
EviCore healthcare will continue to manage prior authorizations for DME services through Feb. 28, 2026.
What this means to your patients through Feb. 28, 2026 · Submit prior authorization requests with dates of service before March 1, 2026, to EviCore as usual. · Continue to refer to EviCore for the most updated prior authorization code lists. · There are no changes to the claims submission or appeals processes.
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Key changes effective March 1, 2026 · DME providers will submit prior authorization requests directly to HealthSpring. · Submit prior authorization requests to HealthSpring for dates of services beginning March 1, 2026. Request prior authorization through Availity Essentials™, our provider portal. · A list of procedural codes requiring prior authorization is available on the clinical review page of our provider website, HealthSpring.com/Providers. · Any authorization issued prior to March 1 will remain valid for those dates and services. That means, any authorizations approved by EviCore before March 1 will remain effective with HealthSpring. You do not need to submit a new prior authorization request.
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How to request prior authorization Request prior authorization through our provider portal, Availity Essentials. This portal is the preferred and fastest method. Refer to Availity for instructions on setting up an account and navigating the portal. If you prefer, you can also call 1-800-914-8252 or fax 1-877-451-5541. |
Step Therapy Requirement
Cigna Medicare Advantatge
The goal of step therapy is to help achieve lower drug prices while maintaining access to drugs for patients.
Certain Part B drugs that currently require precertification will also require step therapy.
The list of drugs that require step therapy can change throughout the plan year.
Cigna Updates
Cigna is pleased to announce we are expanding our Musculoskeletal and Pain Management Program to include select Cigna Medicare Advantage customers.
Beginning June 1, 2021, precertification requests for affected services, including major joint surgery services related to the hip, knee, and shoulder and interventional pain management procedures must be submitted to eviCore instead of Cigna.
CIGNA MEDICARE ADVANTAGE PRIOR AUTHORIZATION PROGRAM – ORIENTATION SESSION SCHEDULE.
Cigna Medicare Advantage has partnered with eviCore healthcare to provide patients with access to high quality, medically appropriate care that is consistent with evidence-based treatment guidelines.
The following procedures will require prior authorization for patients covered by Cigna Medicare Advantage
- Major Joint Services (Hip, Knee, Shoulder)
- Interventional Pain Management Procedures
eviCore healthcare will be leading online orientation sessions designed to assist you and your staff with the new program. For times and how to register click here.
Step Therapy Required for Part B Drugs and Biologics, Revised 2/24/21
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Cigna Medicare Advantage Prior Authorization Program – Orientation Session Schedule
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2021/05/Cigna-MA-MSK-Provider-Orientation-Invitation-03052021.pdf” download=”all” viewer=”google”]
Cigna Medicare Advantage Musculoskeletal and Pain Management Program is Expanding Beginning 6/1/2021
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2021/05/Cigna-MA-Musculoskeletal-and-Pain-Management-Program-2021.04.23.pdf” download=”all” viewer=”google”]
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