Outpatient Rehabilitation

  • For our GAIP members, when to request reviews from Lifewise

    • GAIP is the Graduate Appointee Insurance Program.
    • After 12 visits, providers submit a review request to our care management team to ensure additional sessions are medically necessary.
    • For GAIP members, no eviCore review is required.

    For our ISHIP members, tips for requesting reviews through eviCore healthcare

    • ISHIP is the UW International Student Health Insurance Plan, for Seattle, Bothell and Tacoma campuses.
    • For dates of service June 7, 2018, and after, LifeWise won’t require providers to request a medical necessity review through eviCore healthcare for the first 6 treatment visits of an episode of care (active treatment within a 90-day period) for outpatient rehabilitation services. After the patient’s 6th visit, request a medical necessity review by calling eviCore healthcare at 800-792-8751, from 7 a.m. to 7 p.m., weekdays, or visit the eviCore website created for LifeWise.
    • Reminder: The Physical and Occupational Therapy Services payment policy has specific unit limits for various modalities and services. These limits are enforced in the Claims Editor. To avoid a claim edit, please review the policy.
    • eviCore healthcare offers online training for CorePath. The training is available on the LifeWise page under Resources.
    • Member eligibility can change monthly. Check our prior authorization tool to see if a member needs eviCore healthcare review. The tool instructs you to use eviCore healthcare only when a service requires review.
    • When submitting a request for services, include the member’s alpha prefix and number (such as, “ABC123456789” – no space between the alpha and numeric characters).
    • When you're checking a patient's eligibility and the system says "No authorization required,” you can take a screenshot for your records. We’ll consider this if a retrospective review is required.
    • With some services for oncology, neurodevelopmental, or behavioral health, you might not need authorization. We encourage you to submit the authorization request, anyhow. If the specific services for this member are excluded from the program, we’ll let you know that you don’t have to take any further action.
    • You can check your performance compared to your peers. View your Practitioner Performance Summary reports at eviCore healthcare.

    Outpatient rehabilitation codes

    Check our code list to view outpatient rehabilitation codes.

    Clinical guidelines

    eviCore healthcare occasionally updates their clinical guidelines. Please review the guidelines with your staff and make sure you're using the most current version. Questions? Call eviCore healthcare at 800-792-8751.

    More information

    To create an account and/or initiate an authorization for dates of service on or after July 1, 2016

    Visit eviCore healthcare for:

    • Orientation/training sessions
    • Quick reference guides
    • Clinical guidelines
    • Tutorials
    • FAQ
    • CPT code list
    • Medical necessity review authorization request (available through the clinical certification online tool)
    • Performance summary reports

    eviCore healthcare (formerly known as CareCore National) is an independent company managing outpatient rehabilitation services for LifeWise providers.