1199SEIU members may use their Member Choice-based hospital lab or LabCorp and Quest for lab tests and services. Check our Participating Labs to find one convenient to you.
Some lab tests may be performed in the office. Call our Provider Hotline at (646) 473-7160 or email Providers@1199Funds.org for a list.
- Get a list of laboratory tests that providers may conduct in their offices in Appendix B.
If you are a provider and you don’t already have an account with LabCorp or Quest, our Provider Relations staff can help you set one up. Email us at Providers@1199Funds.org.
Laboratory Management Program for Certain Outpatient Molecular and Genomic Procedures
To help ensure our members are receiving the most clinically appropriate care, we have partnered with eviCore Healthcare (formerly CareCore National) to review certain outpatient Molecular and Genomic tests. Starting May 1, 2014, you must contact eviCore for prior authorization for certain Molecular and Genomic tests associated with the CPT/HCPCS codes on the list below.
In addition to prior authorization, eviCore will review all Molecular and Genomic laboratory procedure claims for coding accuracy and medical necessity. Refer to the procedure category and CPT/HCPCS code range on the below listing. We urge you to update your claims submission systems and coding practices accordingly to avoid payment delays or unnecessary denials.
If you receive an adverse payment decision as a result of eviCore’s code policies, you may submit a request for claim review directly to eviCore. You should fax requests to (844) 545-9214 or mail to eviCore Healthcare, 400 Buckwalter Place Blvd., Bluffton, SC 29910. Include a copy of the claim, eviCore correspondence, information about the determination to be reviewed and any pertinent documentation to support your review request.
How to Request Prior Authorization for Molecular and Genomic Testing
- Online: Register for free at eviCore (formerly CareCore National) and log into the “Ordering Provider Login.” You may be able to receive an immediate authorization if your patient meets the coverage criteria.
- By phone: Call eviCore toll-free at (888) 910-1199, Monday through Friday, from 7:00 am to 7:00 pm in all time zones.
- For urgent requests: If services are required in less than 48 hours due to medically urgent conditions, please call eviCore’s toll-free number at (888) 910-1199 for expedited authorization reviews. Be sure to tell the eviCore representative that the authorization is for medically urgent care.
Note: The initial authorization request will NOT be accepted via FAX by eviCore.
Note: eviCore will not accept post-service authorization requests.
If you have any questions about this program, please contact your Provider Representative, or call our Provider Relations Call Center at (646) 473-7160, Monday through Friday, from 8:00 am to 6:00 pm.
- eviCore Lab Management Quick Reference Guide – one page document listing the information necessary to submit a prior authorization along with some contact information.
- Frequently Asked Questions (FAQs)
- Unique Test Identifier FAQs
- Laboratory Management Clinical Policy Manual (eviCore/1199SEIU Funds Lab Resources)
- Codes Requiring Prior Authorization (eviCore/1199SEIU Funds Lab Resources)
- Complete Code List under eviCore Laboratory Management Program (eviCore/1199SEIU Funds Lab Resources)