Evicore ePA Site Specific Terms

Version 1.0, November 17, 2023

These Site Specific Terms set forth additional terms and conditions for this website (the “Site”) and supplement the Terms of Use applicable to the Site.

To the extent that there are conflicts between these Site Specific Terms and the Terms of Use, these Site Specific Terms shall control. These Site Specific Terms and the Terms of Use are between a user of any portion of the Site and EviCore Healthcare MSI, LLC d/b/a EviCore healthcare (“Evicore”, “we”, “us” or “our”).

SITE PURPOSE

This portion of the Site is made available to facilitate Portal access. Registered Users are provided access to the Portal and to information and online services not otherwise available through the Site, as well as the ability to login to the Portal when revisiting the Site.

REGISTRATION REQUIRED TO USE PORTAL

“User” is anyone utilizing the Site. Each individual User must establish and use their own account to access the Portal. Certain types of Users may register for Portal access directly through the Site, while other types of Users must contact us to register for Portal access. “Registered Provider Users” are Users who are providers, facilities, or representatives or authorized agents of providers or facilities, that have been granted access to the Portal. “Registered Client Users” are Users who are employees of a client of EviCore or its affiliates that have been granted access to the Portal.

“Portal” means any one or more registered User-only portals available through the Site, a third-party site, or via mobile access which enables Registered Provider Users and /or Registered Client Users to facilitate electronic authorization (e.g., for pharmacy or medical) for a patient or member of a delegated client of EviCore or its affiliates. Only Registered Provider Users are authorized to use the Portal for their associated patients for facilitating authorization review (and in the manner described below). Only Registered Client Users are authorized to use the Portal for performing certain authorization and other role-based actions. Use of the Portal by any other person, or for any other purpose not specifically authorized in these Site Specific Terms or the Terms of Use, is strictly prohibited.

By registering to become one of our Registered Provider Users, you agree that you are a duly licensed, registered, and/or authorized care provider, or a duly authorized employee thereof, and have all rights and permissions under contract, law, and professional practices to utilize the Portal as contemplated under these Site Specific Terms and as made available to you through the Portal.

By registering to become one of our Registered Client Users, you agree that you are an employee of a client of EviCore or its affiliates, and have all rights and permissions under contract, law, and professional practices to utilize the Portal as contemplated under these Site Specific Terms and as made available to you through the Portal.

ACCOUNT MANAGEMENT

In certain instances of the Portal, after registration you link providers to your account to enable you to check the authorization status of the associated providers. In addition, linking may allow you to select a linked provider when requesting an authorization. You agree to maintain the accuracy of your contact information as reflected in the Portal so that we can continue to accurately communicate with you.

USER CREDENTIALS

Depending upon the Portal implementation available to you, you may register for the Portal by (i) establishing Portal login credentials to use with the Portal and, in some instances, other EviCore portals, other portals that are affiliated with EviCore and/or portals that are associated with third parties, (ii) utilizing previously established EviCore login credentials, (iii) utilizing previously established login credentials associated with an entity affiliated with EviCore, and/or (iv) utilizing login credentials associated with a third party with whom EviCore has an established access relationship. If more than one set of login credentials are associated with the account of the Registered User, you may be able to interchangeably use them to access the Portal. Regardless of the login credentials used, your account associated with the Portal is the same.

If you reset your third party credentials directly with the third party platform, the resetting should not affect your access to the Portal. By using third party credentials to access the Portal (or the Site), certain information may be provided to us by the third party platform or otherwise.

REQUESTING AN AUTHORIZATION

After your login to the Portal as one of our Registered Provider Users, you may request an authorization for health care services, supplies, or medications (“Healthcare Services, Supplies, or Drugs”). Upon your selection of Healthcare Services, Supplies, or Drugs, you will be prompted to select or enter your associated provider information. After completion, you will be prompted to provide patient eligibility lookup information for a patient that is in a provider-patient relationship with you or your associated provider. Upon completion, eligibility is verified and associated patient identification results, if identified, are provided. If you select the patient, you will then be prompted to provide clinical, drug, and/or medical related information associated with the authorization request for the patient. Once this inquiry request is submitted, we may request additional clinical and patient information associated with the authorization request. When requested, the information is ordinarily necessary to process the authorization request; you may be able to upload certain documents as part of this request. After submission or, if not otherwise. necessary, we will communicate an approval, an indication that a clinical review is needed, or otherwise. You may be able to view the status of your request (including, depending on implementation, status, authorization or other summary notes, and previously uploaded documents) through use of a dashboard available through the Portal. If you are unable to complete and submit the request once started, you may be able to continue with your submission through the dashboard.

AUTHORIZATION LOOK UP

In certain instances, by providing certain information into the Portal, you can review the status and review certain information associated with any of your previously submitted authorization requests or, for Registered Client Users, previously submitted authorization requests associated with the Registered Client User’s patients or members.

CLIENT ROLE FUNCTIONALITY

Depending on your role within the Portal, an authorized representative of a client may request that you receive additional Portal functionality for processing of certain categories of authorization or exception requests. Once granted, and consistent with job function, you may act on these requests within the Portal.