EviCore by Evernorth

Our Cardiovascular solution delivers cost savings and improved patient outcomes by ensuring health plan members receive the appropriate test or treatment necessary for their individual cardiovascular-related case presentation or condition.

Our Musculoskeletal (MSK) utilization management solution addresses the full spectrum of potential care and treatment, from holistic and conservative approaches to more advanced procedures. We then apply up-to-date evidence-based guidelines and advanced technologies to ensure that the right care is delivered for safe, effective, and affordable MSK care.

The comprehensive, patient-centered oncology management solution combined Utilization Management and concierge support, helping to improve care quality and affordability, simplify the provider experience, and reduce the cost of care for patients and health plans. 

Our Home Health solution offers enhanced utilization management and care coordination to help ensure that members receive quality, clinically appropriate home-based care to support them in achieving their health goals. We offer added value with our national network of quality home health agencies that connects members to providers on behalf of our health plan clients.

Our Consumer Engagement programs offer a variety of solutions that educate patients through personalized interactions. From SmartChoice site redirection and alternative therapy programs, to HEDIS and Star programs, our Consumer Engagement programs deliver innovative, informed options and cost transparency.

EviCore intelliPath^® is where automation and interoperability meet. For EviCore by Evernorth, it’s the future of better, faster utilization management processes. It’s the key to creating a touchless prior authorization experience for providers by both seamlessly connecting to the patient data available in their EMR and automating the underlying workflow to reduce the burden of tedious tasks.  

We provide our clients with an immediate savings opportunity through our Durable Medical Equipment solution. Our enhanced utilization management and care coordination capabilities help ensure that patients receive clinically appropriate equipment to create improved health outcomes. Additionally, we also offer a national network of high-quality DME providers and can manage DME provider relationships on behalf of our health plan clients.

The Radiation Oncology solution uses the most up-to-date evidence-based clinical guidelines from peer-reviewed literature, professional societies, and leading cancer physician experts to ensure that patients achieve optimal clinical and financial outcomes.

Our solution directs oncology physicians to the best treatment options for each patient, based on their unique diagnosis, medical history, pathology, prior therapy, functional status, and disease severity. We also ensure payment integrity by reviewing the appropriateness and accuracy of billed claims.

The Gastroenterology solution applies a uniquely comprehensive approach to help improve patient outcomes and control costs. We not only promote appropriate evidence-based use of endoscopic procedures via utilization management, we also provide site-of-care redirection to high-value, lower-cost facilities where appropriate, and help to close gaps in necessary preventive care through patient outreach as part of our Colorectal Cancer Screening Program.

Our Radiology solution ensures health plan members receive the most appropriate test or treatment necessary for their individual medical needs, delivering cost savings, reducing inappropriate utilization and improving patient outcomes. Our approach is not to deny care that is needed but rather to redirect providers and patients to more appropriate testing and treatment options, which helps ensure safety and maximize value.

Our Site of Care solution ensures patients receive care at the highest-quality, lowest-cost and most convenient setting, helping to lessen the burden on providers, improve the patient care experience, and reduce costs for patients and health plans. 

Our Laboratory Management solution utilizes both broad and test-specific medical policies to improve the quality of clinical decisions for patients while reducing laboratory costs for genetic, molecular and genomic testing. This solution helps ensure that health plans pay the right amount, on the right claim, for the appropriate test. The core components are medical policy, prior authorization (PA), payment integrity, and lab network.

Since 2008 our Sleep solution has offered an end-to-end solution for the episode of care for sleep apnea diagnosis and treatment as well as for ongoing compliance with treatment. Our solution manages the utilization of sleep diagnostic procedures and positive airway pressure (PAP) therapy devices and supplies on the front end of a diagnosis and works to improve long-term adherence to PAP compliance on the back end. In addition, EviCore can help health plans identify high-quality providers of diagnostic testing and PAP therapy.      

Medical oncology uses the most up-to-date evidence-based clinical guidelines from the National Comprehensive Cancer Network (NCCN®) to ensure patients achieve optimal clinical and financial outcomes. Our solution guides providers to NCCN-recommended treatment plans for each unique patient by using dynamic algorithms that minimize provider administrative time. By capturing only the clinically relevant information for each case, we present providers with clinical decision support and approval for a complete episode of care in as little as four minutes.