EviCore

American healthcare company

eviCore healthcare, formerly known as CareCore National, is a company that provides healthcare solutions and services, primarily focusing on utilization management and prior authorization for health insurance plans. The company is headquartered in Bluffton, South Carolina, and operates across the United States.

History

CareCore National headquarters

eviCore healthcare was originally founded as CareCore National in 1994. The company was established to address the growing need for effective management of healthcare services and costs. Over the years, eviCore has expanded its services to include a wide range of healthcare management solutions, including radiology, cardiology, oncology, and musculoskeletal services.

In 2014, CareCore National merged with MedSolutions, another leader in the healthcare management industry, to form eviCore healthcare. This merger allowed the company to broaden its service offerings and enhance its capabilities in managing complex healthcare services.

Services

eviCore healthcare provides a variety of services aimed at improving healthcare outcomes and reducing costs. These services include:

• Utilization Management: eviCore offers utilization management services to ensure that patients receive appropriate and necessary medical care. This involves reviewing and authorizing medical services based on established guidelines and criteria.

• Prior Authorization: The company provides prior authorization services to help health plans manage the approval process for certain medical procedures and treatments. This helps ensure that patients receive the right care at the right time.

• Clinical Guidelines: eviCore develops and maintains clinical guidelines that are used to evaluate the medical necessity of various healthcare services. These guidelines are based on evidence-based medicine and are regularly updated to reflect the latest medical research and standards.

• Provider Collaboration: eviCore works closely with healthcare providers to ensure that patients receive high-quality care. The company provides tools and resources to help providers navigate the prior authorization process and improve patient outcomes.

Impact on Healthcare

eviCore healthcare plays a significant role in the healthcare industry by helping to control costs and improve the quality of care. By managing the utilization of healthcare services, eviCore helps prevent unnecessary procedures and tests, which can lead to cost savings for both patients and health plans.

The company's focus on evidence-based guidelines and collaboration with providers also contributes to improved patient outcomes. By ensuring that patients receive appropriate care, eviCore helps reduce the risk of complications and improve overall health outcomes.

Related pages

• Health insurance in the United States
• Utilization management
• Prior authorization
• Healthcare in the United States