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Molecular testing utilization management program

Wellmark is collaborating with eviCore® healthcare to provide utilization management services for molecular lab testing. Beginning Oct. 1, 2023, select molecular lab tests for Wellmark commercial members will require authorization.

Prior Authorization

Wellmark’s Medical Authorization Table can be used to determine which services require prior authorization through eviCore.

Medical Policies

Wellmark’s medical policies for molecular testing procedures can be reviewed on eviCore’s website External Link.

Check Member Coverage

Providers should always validate member coverage includes the molecular testing utilization management program by using the Check Member Information tool Secure Site located on the Wellmark provider portal.*

The molecular testing prior approval language will be in the Notification Section of EVBI.

Please note that this tool is not available to out-of-network providers. Out of network providers can contact customer service for member eligibility in the program.

Authorizations through eviCore will only be for molecular testing codes. Out-of-network approval should be obtained by a network provider prior to any non-molecular testing services being performed by an out-of-network provider. Submit the request using Wellmark’s Medical Authorization Tool, Jiva. For more information, please reference the Health Services section of the Wellmark provider guide Secure Site.

eviCore Contact Information

The eviCore Healthcare Web Portal is available 24/7 and can be accessed through Wellmark’s Medical Authorization Table.

Providers can call eviCore toll-free at 1-844-253-9502 from 7:00 a.m. to 7:00 p.m. CST Monday through Friday.

Available Training

Online orientation sessions will be held to assist providers with the new program. Sessions will last approximately one hour and will be held on the following dates and times:

  • Tuesday, September 12 at 10:00 a.m. CST
  • Thursday, September 14 at 1:00 p.m. CST
  • Tuesday, September 19 at 9:30 a.m. CST
  • Monday, October 2 at 12:30 p.m. CST

Follow these instructions on how to register PDF File for one of the above sessions.

Providers can also visit eviCore’s dedicated Wellmark page External Link for additional information.

eviCore® is an independent company that will manage the prior authorization process for molecular lab testing on behalf of Wellmark.

*Program requirements will be implemented at a later date for select self-funded groups.

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