Post-Acute Care Utilization Management Program - Provider Orientation - Initial & Concurrent Prior Authorization Guide

Sep 17, 2026

Upload by McQueen

Provider orientation presentation for the Post-Acute Care Utilization Management Program covering John’s Hopkins Health Plantation and EviCore by Evernorth PAC program processes. It outlines agenda topics including post-acute program overview, prior authorization requirements, how to submit requests, outcomes and special considerations, and transitional care. Content specifies covered inpatient post-acute facility services (SNF, IRF, LTAC), initial and concurrent request workflows, responsibility split between hospitals and PAC facilities, eligibility verification sources, timing and response expectations, expiration rules, date-extension criteria, and provider portal usage plus Q&A contact guidance.

LanguageEnglish

CategoryPresentations

FormatPDF

Pages55

Reading Time19 min

AccessFree to download

Post-Acute Care Program Overview

Prior Authorization Requirements

Submitting Prior Authorization Requests

Prior Authorization Outcomes & Special Considerations

Transitional Care Program Overview

Provider Resources

Provider Portal Overview

EviCore Portal Registration

Creating and Searching Cases

Q & A

Post-Acute Care Utilization Management Program John’s Hopkins Health Plantation Provider Orientation © 2025 EviCore healthcare. All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY information. Agenda • Post-Acute Care Program Overview • Prior Authorization Requirements • Submitting Prior Authorization Requests • Prior Authorization Outcomes & Special Considerations • Transitional Care Program Overview • Provider Resources • Provider Portal Overview • EviCore Portal Registration • Creating and Searching Cases • Q & A © 2025 EviCore healthcare. All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY information. Post-Acute Care Program Overview © 2025 EviCore healthcare. All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY information. EviCore by Evernorth PAC Program Overview EviCore will accept initial and concurrent benefit preauthorization request for member admissions to the following Inpatient PostAcute Care (PAC) facilities: | Precertification applies to the following services: | | --- | | • Skilled nursing facilities (SNF)
• Inpatient rehabilitation facilities (IRF)
• Long-term acute care facilities (LTAC) | • Hospitals are responsible to submit the initial post-acute care prior authorization request • PAC facilities (listed above) are responsible to submit date extensions (PAC concurrent review) • Custodial Care does not require prior authorization by EviCore and will continue to be managed by JHHP • Once the patient is discharged from the post-acute facility, the patient will be referred to JHHP for continued care management services • If a member is transferred to the hospital directly from a PAC facility and stays >24 hours, a new prior authorization is required and should be requested by the hospital prior to discharge © 2025 EviCore healthcare. All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY information. Prior Authorization Requirements © 2025 EviCore healthcare. All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY information. EviCore Prior Authorization Requirements EviCore manages all Inpatient Post-Acute Care (PAC) preauthorization requests for John’s Hopkins Health Plan (JHHP) members enrolled in the following programs: | Medicare | | --- | | • Advantage MD | | Medicaid | | --- | | • Priority Partners | To verify eligibility and benefits: Providers should verify member eligibility and benefits on: Johns Hopkins Health Plans-connect Sign In • Eligibility may also be verified on the EviCore provider portal: Homepage | EviCore by Evernorth © 2025 EviCore healthcare. All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY information. Initial Post-Acute Care Admission Requests Pre-Authorization Overview Hospital initiates prior authorization requests: • The hospital is responsible to submit post-acute care prior authorization requests, unless the post-acute care facility (i.e. IRF) has the same NPI or Tax ID \# • EviCore requests that you start the process as soon as possible to facilitate a timely pre-authorization determination • Begins on day 1 of Hospital admission • Hospital staff makes a recommendation for postacute level of care • Contact EviCore Provide prior authorization form and clinical information to support medical necessity for admission to post-acute level of care • Approval of prior authorization for level of care request • Request for additional clinical information • Unable to approve on initial UM review Our goal is a 24-48 hour response time; add an additional 2 business days if a peer to peer review is requested, however our typical response time is less © 2025 EviCore healthcare. All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY information. Post-Acute Care Facility Prior Authorization Overview EviCore w

FAQs

Which post-acute care facilities and services require EviCore precertification?

EviCore precertification applies to skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and long-term acute care facilities (LTAC). Custodial care does not require EviCore prior authorization and continues to be managed by JHHP.

Who submits initial and who submits date extensions for post-acute prior authorization?

Hospitals submit the initial post-acute care prior authorization request unless the IRF has the same NPI or Tax ID. PAC facilities listed for the program submit date extensions for PAC concurrent review.

How long does EviCore take to respond, and how does peer-to-peer affect timing?

The stated goal is a 24–48 hour response time. An additional 2 business days are added if a peer-to-peer review is requested.

Sep 17, 2026

Upload by McQueen