Prior authorization with eviCore

On April 1, 2017, we will be replacing AIM Specialty Healthcare with utilization management programs for advanced imaging (cardiology, radiology, ultrasound) and musculoskeletal services (spine/joint surgery, spine/joint pain management and alternative care) with eviCore healthcare.

This change impacts how providers request and obtain prior authorizations for medical services.

Please note: if a member sees a provider who is out of network it may lead to higher out-of-pocket costs. The member cost will vary based on the following conditions:

Why we focus on utilization management

Utilization management (UM) includes medical reviews for services that require prior authorization. Following evidence-based care guidelines, UM helps ensure patients receive the highest quality of care and avoid paying more for unneeded services or treatments. While the adoption of evidence-based care protocols remains an industry challenge, UM supports medically appropriate care through responsible decision-making and better cost management.

Our partnership with eviCore is focused on providing patients with the highest quality of care at the lowest cost. With eviCore's streamlined prior authorization process, your employees get cost-effective, quality care when they need it.

Questions?

We're here to help. Please contact your sales representative or account services representative.

To learn more about Moda's prior authorization services through eviCore, please see our FAQ.

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Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

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