We have heard from our Eviti users that you are not sure where to go for assistance. Often, you call the health plan, only to be referred back to Eviti or vice versa. We understand this can be frustrating and want to help you understand where to go when you have questions.
What to remember:
- Eviti is contracted by the Health Plan to provide Decision Support or “Pre-Authorization” services.
- Our role is to review the proposed treatment for the health plan and ensure that the patient is receiving the best care option for their disease process.
- The final Authorization decision is made by the Health Plan.
When to Call Eviti:
- Generally, any question you have before an Eviti code is generated.
- Issues with logging into Eviti
- Error messages in the Eviti portal (patient not found, etc.)
- Questions or assistance with entering treatment into Eviti (also called Clinical Walkthrough)
- Questions or assistance with sending medical records to Eviti
- Responding to questions from our Medical Office or Peer to Peer requests
*Note: Eviti cannot make changes to a treatment once the Eviti Code or rejection is generated because the treatment plan has already been sent to the Health Plan for their decision.
When to call the Health Plan:
- Questions regarding Member Eligibility (is the member covered?)
- Questions regarding if an authorization is required
- After an Eviti Code or rejection determination is made by Eviti
- Status of authorization
- Questions regarding what is covered or approved
- Date extensions on authorizations
- Site of service changes on authorizations
- Changes to Pharmacy vs Buy and Bill indications on the treatment plan
If you are interested in shaping the future of Eviti, consider joining our User Panel by completing the form here.
Interested in previous You Asked Eviti Answers topics?
You can find the first topic from September here and the second topic from October here.