Medical Review Programs

eviCore healthcare

The Benefit Funds have partnered with eviCore healthcare (formerly CareCore National) to pre-authorize and review claims for high-tech radiology and nuclear cardiology scans, radiation therapy, medical oncology treatments and certain outpatient molecular and genomic laboratory services. This partnership will allow providers to access eviCore’s experts, as well as their nationally recognized evidence-based guidelines and criteria, to help ensure that 1199SEIU patients receive clinically appropriate care in a timely manner.

Each program has its own page, which includes specific requirements and key information. As our programs are subject to updates, we encourage you to view the program pages on a regular basis to ensure you have the most up-to-date information.

In addition to prior authorization, eviCore will review claims for coding accuracy and medical necessity. We urge you to update your claims submission system and coding practices accordingly to avoid payment delays or unnecessary denials.

Further Detail on Each Program

Molecular and Genomic Laboratory Services »
Radiology Imaging/Nuclear Cardiology Services »
Radiation Therapy »
Medical Oncology Services »

Access eviCore healthcare’s 1199SEIU provider web page »

Save Time and Receive Immediate Response! Submit your eviCore Prior Approval Requests Electronically

eviCore offers an immediate response and an email notification through its online portal to authorization requests that meet the 1199SEIU Benefit Funds’ criteria. To help familiarize you with this online option, we invite you to participate in one or more upcoming webinars.