June 7, 2018
For dates of service June 7, 2018, and after, we won’t require providers to request a medical necessity review through eviCore healthcare for the first 6 treatment visits of an episode of care (active treatment within a 90-day period) for outpatient rehabilitation services.
- We’ll allow an initial evaluation and management visit and up to 6 subsequent visits without a treatment plan on file. Note: We reserve the right to do reviews for medical necessity for any medical services provided.
- After the 6 consecutive visits, providers must submit a request for medical necessity review to eviCore healthcare for any on-going treatment.
Reminder: All requests are subject to a member’s eligibility and benefit limits at the time of service.