Program management
Wellmark collaborates with EviCore to provide select utilization management services.
Programs include:
- Molecular testing (lab), including post-claim reviews
- Advanced imaging (radiology and cardiovascular imaging)
- Cardiac implantable devices
Visit the dedicated Wellmark page on EviCore’s website for information.
These programs do not apply to Wellmark Advantage Health Plan® or Federal Employee Program (FEP) members.
Prior authorization is never required for Wellmark members with Medicare as their primary coverage (this includes members with Medicare Part A only).
Providers who are not contracted directly with Wellmark (including out-of-area providers) are not required to complete prior authorizations for advanced imaging and cardiac implantable devices.
Start here:
- Access Wellmark’s Medical Authorization Table to determine which services require prior authorization (PA) through EviCore and find tools for submission.
- Check member benefits before delivering services.
- Review the medical policies, known as clinical guidelines, located on EviCore’s website.
- Explore the Wellmark page on EviCore’s website for information on each program, specific training, FAQs and more.
A Live Chat feature is available 24/7 in the EviCore Healthcare Web Portal, accessed through Wellmark's Medical Authorization Table.
If you are experiencing portal issues, please call toll-free 800-646-0418 from 7:00 a.m. to 7:00 p.m. CST Monday through Friday (Option 2) or submit a Web Portal Support request using EviCore’s Communication Relationship Management (ECRM) portal.
Provider resources for the ECRM portal are located at www.evicore.com/ecrm-resources.
Contact EviCore PA Intake Call Center at 844-253-9502 from 7:00 a.m. to 7:00 p.m. CST Monday through Friday.
Get help with creating an initial PA case, updating a current case, or checking the status of a current case (including answers on post-service medical record requests with claim denial codes VER and VEY).
Currently only applicable to Molecular Testing
Contact the EviCore Claims Research/Support Team at 866-221-8787 from 7:00 a.m. to 7:00 p.m. CST Monday through Friday or submit a Provider Services request for claim research/support using EviCore’s Communication Relationship Management (ECRM) portal.
Provider resources for the ECRM portal are located at www.evicore.com/ecrm-resources.
Get help with the claim review process, understanding claim denials, post-service record requests and more.
Do not use EviCore claim inquiry to submit unsolicited medical records for post-service review. The EviCore claim inquiry is an opportunity to understand the clinical guideline and claim denial reason and will not result in a claim adjustment. Following an EviCore claim inquiry, providers must submit an appeal directly to Wellmark to file a post-service appeal and submit clinical documentation for review.
Contact EviCore's Client & Provider Services at 800-646-0418 from 7:00 a.m. to 7:00 p.m. CST Monday through Friday (Option 4) or submit a Provider Services request using EviCore’s Communication Relationship Management (ECRM) portal.
Provider resources for the ECRM portal are located at www.evicore.com/ecrm-resources.
Disclosure
EviCore by Evernorth® is a separate company that provides authorization services on behalf of Wellmark Blue Cross and Blue Shield.