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Outlines company highlights, scale of managed members and claims, integrated lab and clinical operations, and a multi-specialty clinical platform. Presents an evidence-based approach grounded in pediatric guidelines and contributions from community physicians, academic experts, current clinical literature, and alignment with major national societies. 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All Rights Reserved. This presentation contains CONFIDENTIAL and PROPRIETARY information.  \nCompany Highlights  \n4K employees  \nincluding 1K clinicians  \nHeadquartered in Bluffton, SC Offices across the US including:  \n• Lexington, MA  \n• Colorado Springs, CO  \n• Franklin, TN  \n• Greenwich, CT  \n• Melbourne, FL  \n• Plainville , CT  \n• Sacramento, CA  \nSHARING  \nA VISION  \nAT THE CORE OF CHANGE.  \n100M members managed nationwide  \n   12M claims  processed annually  \nIntegrated Solutions  \nLAB MANAGEMENT 19M lives  \nMEDICAL ONCOLOGY 14M lives  \nRADIATION THERAPY 29M lives  \nSPECIALTY DRUG 100k lives  \nMUSCULOSKELETAL 34M lives  \nRADIOLOGY 65M lives  \nCARDIOLOGY 46M lives  \nSLEEP 14M lives  \nPOST-ACUTE CARE  \n320k lives  \n| | • 10 years’ experience-since 2006\u003Cbr>• 20+ regional and national clients\u003Cbr>• 46M total membership\u003Cbr>• 37.7M Commercial membership |  |\n| --- | --- | --- |\n| Cardiology Solution Experience | • 2.3M Medicare membership\u003Cbr>• 5.98M Medicaid membership |  |\n|  | |  |\n\nOur Clinical Approach  \nClinical Platform  \nMulti-Specialty Expertise  \nFamily Medicine Internal Medicine  \nOncology/Hematology Surgery  \nPediatrics  \nSports Medicine  \nOB/GYN  \nCardiology  \nNuclear Medicine  \nAnesthesiology  \n• General  \n• Orthopedic  \n• Thoracic  \n• Cardiac  \n• Neurological  \n• Otolaryngology  \n• Spine  \nRadiology  \n• Nuclear Medicine  \n• Musculoskeletal  \n• Neuroradiology  \n• 190+ board-certified medical directors  \n• Diverse representation of medical specialties  \n• 450 nurses with diverse specialties and experience  \n• Dedicated nursing and physician teams by specialty for Cardiology, Oncology, OB-GYN, Spine/Orthopedics, Neurology, and Medical/Surgical  \nEvidence-Based Guidelines  \nThe foundation of our solutions:  \nDedicated pediatric guidelines  \nContributions from a panel of community physicians  \nExperts associated with academic institutions  \nCurrent clinical literature  \n Aligned with National Societies  \n• American College of Cardiology  \n• American Heart Association  \n• American Society of Nuclear Cardiology  \n• Heart Rhythm Society  \n• American College of Radiology  \n• American Academy of Neurology  \n• American College of Chest Physicians  \n• American College of Rheumatology  \n• American Academy of Sleep Medicine  \n• American Urological Association  \n• National Comprehensive Cancer Network  \n• American College of Therapeutic Radiology and Oncology  \n• American Society for Radiation Oncology  \n• American Society of Clinical Oncology  \n• American Academy of Pediatrics  \n• American Society of Colon and Rectal Surgeons  \n• American Academy of Orthopedic Surgeons  \n• North American Spine Society  \n• American Association of Neurological Surgeons  \n• American College of Obstetricians and  Gynecologists  \n• The Society of Maternal-Fetal Medicine  \nService Model  \nClient Provider Operations  \nThe Client Provider Operations team is responsible for high-level service delivery to our health plan clients as well as ordering and rendering providers nationwide  \nClient Provider Representatives  \nClient Provider Representatives are cross-trained to investigate escalated provider and health plan issues.  \nClient Service Managers  \nClient Service Managers lead resolution of complex service issues and coordinate with partners for continuous improvement.  \nRegional Provider Engagement Managers  \nRegional Provider Engagement Managers are on-the-ground resources who serve as the voice of eviCore to the provider community.  \nWhy Our Service Delivery Model Works  \nOne centralized intake point  \nallows for timely identification, tracking, trending, and reporting of all issues. It also enables eviCore to quickly identify and respond to systemic issues impacting multiple providers.  \nComplex issues are escalated to resources who are the subject matter experts and can quickly coordinate with matrix ","cbCaif1GoBswqvgY","https://ap.wps.com/l/cbCaif1GoBswqvgY","pdf",2269702,9,63,"English","# Provider Orientation\n## Company Highlights and Integrated Solutions\n## Our Clinical Approach\n## Service Model and Service Delivery Operations","[{\"question\":\"What programs does the cardiology prior authorization apply to?\",\"answer\":\"It applies to Blue Cross and Blue Shield Medicare and Medicaid programs.\"},{\"question\":\"What is emphasized in the clinical approach for cardiology?\",\"answer\":\"The presentation emphasizes multi-specialty expertise and evidence-based guidelines supported by pediatric guidelines, expert contributions, current literature, and alignment with national societies.\"},{\"question\":\"How does the service delivery model handle issues?\",\"answer\":\"It uses one centralized intake point for tracking and reporting, escalates complex issues to subject matter experts for coordination, and handles routine issues through cross-trained representatives.\"}]","Prior Authorization of Cardiology - Provider Orientation | PDF",1789634153,22]