eviCore has updated corePath for physical and occupational therapy authorizations

Effective immediately, eviCore healthcare^® has made changes to the corePath^SM therapy authorization model for initial authorization requests for new episodes of treatment. This change applies to:

• Physical therapy providers in categories B and C
• Occupational therapists in category B

Here’s what changed

For providers in categories B and C: When initial authorization requests meet certain conditions, eviCore is approving a greater number of visits over a longer authorization duration period. The logic in eviCore’s corePath model determines the number of visits and authorization duration based on the patient’s condition and complexity of the condition.

For more information about how this affects occupational therapy providers, see eviCore’s Physical Therapy Practitioner Performance Summary and Provider Category FAQs document.** Information is located under How does my category impact my authorization requirements for occupational therapy?

Note: There haven’t been any changes to the number of visits granted or the authorization duration period for providers in category A.

Additional information

To learn more about category assignments, see eviCore’s Physical Therapy Practitioner Performance Summary and Provider Category FAQs document.**

You can find additional information on the ereferrals.bcbsm.com website:

• On Blue Care Network’s Outpatient PT, OT, ST page
• On Blue Cross’ eviCore-Managed Procedures page. Look in the Medicare Plus Blue PPO members section.

As a reminder, eviCore manages physical therapy and occupational therapy services for non-autism diagnoses for Medicare Plus Blue^SM, BCN commercial and BCN Advantage^SM members. eviCore also manages physical therapy and occupational therapy services for adult BCN commercial members ages 19 and older with autism diagnoses.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.