To accept and process clinical uploads or faxes, EviCore requires a full name (first and last) and one additional identifier from the list below:
- Date of birth
- Correct case number/episode ID
- Member ID number
- Full address (street, city, state and zip code)
- Full phone number, including area code
- Driver’s license number or other government-issued ID
Patient identity verifiers are not required on every page, though they are recommended. If no conflicting identifiers are present, it is acceptable to assume each page is a continuation of the prior page. A cover page with two patient identifiers will satisfy HIPAA verification if no patient discrepancy is present within subsequent pages.
If an upload or a fax does not have two pieces of identifying information and member protected health information (PHI) cannot be validated, then we are unable to accept the document per HIPAA policy.
For any questions or concerns on this matter, please reach out to your area’s provider engagement manager.