In order to be able to use this feature, Please complete your account type association at the bottom of the page. You can click on Go Back if you want to do this at a later time.* Required Field
Please review the information before you submit this registration. An Email will be sent to your registered email address to set your password.
Web Portal Preference
Please select the Portal that is listed in your provider training material. This selection determines the primary portal that you will using to submit cases over the web.
Default Portal*:
User Information
All Pre-Authorization notifications will be sent to the fax number and email address provided below. Please make sure you provide valid information.
User Found with Same FirstName, LastName and Email
User Name*:
Email*:
Confirm Email*:
First Name*:
Last Name*:
Address*:
City*:
State*:
Zip*:
Office Name*:
Fax Verification code:
Phone*:
Ext:
Fax*:
Individual NPI*:
Status:
User Registration
UserName:
Email:
Account Type:
First Name:
Last Name:
Address:
City:
State:
Zip:
Office Name:
Phone:
Ext:
Fax:
Individual NPI:
Provider Information
Payer Information
Facility Name:Billing Office Name:
Physician FirstName:
Physician LastName:
Street Address:
Zip Code:
State:
Tax ID:
Individual NPI:
Health Plan Name
NPI Validation
Please select Phone/Fax Number by selecting verification type.
Verification Type:
Phone Number:
Fax Number:
NPI Validation
We are currently unable to verify this NPI. Please update the NPI registry database with current contact information and resubmit once the updates are finalized.
User Access Agreement*Required
eviCore
Provider/Customer Access Agreement for Web-Based Applications
This Provider/Customer Access Agreement for Web-Based Applications ("Access Agreement") contains the terms and conditions for use by Provider/Customers of the web-based applications provided by eviCore through its Web Site. This Access Agreement applies to Provider/Customer and all employees and/or agents that have access to eviCore's web-based applications by utilizing a User ID and Personal Identification Number ("PIN"), Security Password, or other security device provided by eviCore, hereinafter referred to as "Users."
To obtain access to eviCore’s Web Site applications, User must first read and agree to this Access Agreement. After reviewing these documents, User will be asked to accept the Access Agreement by checking the "Accept Terms and Conditions" check box. If User accepts, this will result in a binding contract between User and eviCore, just as if User had physically signed the Access Agreement.
Each and every time User accesses eviCore’s web-based applications, User agrees to be bound by this Access Agreement, as it may be amended from time to time.
Limited License. Upon acceptance, eviCore grants Provider/Customer a revocable, nonexclusive, and nontransferable limited license to access electronically eviCore’s web-based applications only so long as Provider/Customer is currently bound by a Provider/Customer Agreement (as used herein a "Provider/Customer Agreement" is an agreement to provide health care/medical services to members of health plans for which eviCore provides radiological services, whether it is with eviCore directly or said health plan(s)). The electronic access to and use of eviCore’s web-based applications is subject to the provisions of the Provider/Customer Agreement and this Access Agreement. eviCore, in its sole discretion, may terminate this license at any time for any reason.
Limitations on Use. Use of eviCore’s web-based applications, and the information contained therein, is solely for Provider/Customer’s professional use for purposes of carrying out Provider/Customer’s obligations under the Provider/Customer Agreement. Any other use requires written permission in advance from eviCore. Any unauthorized use of the web-based applications or the information contained therein is prohibited.
Responsibility for Agents and Employees. To the extent that Provider/Customer grants permission to agents and/or employees to access eviCore’s web-based applications pursuant to this Access Agreement, Provider/Customer agrees to be responsible for ensuring that each individual User abides by the terms of this Access Agreement. If Provider/Customer becomes aware that there has been unauthorized access or use, Provider/Customer must notify eviCore immediately.
Registration. Access to eviCore’s web-based applications requires each User to register. User agrees to provide eviCore with accurate and complete registration information and to inform eviCore of any changes to that information.
Provider/Customer Duties. Provider/Customer shall designate a contact person for receipt of notices and information from eviCore regarding this Access Agreement and eviCore’s web-based applications. Provider/Customer and/or the contact person shall be responsible for:
Providing and updating a list of Users authorized to access eviCore’s web-based applications pursuant to this Access Agreement and their appropriate level of access. eviCore can rely upon modification to the list of Users, including modification received by electronic means from the Provider/Customer or contact person.
Notifying eviCore immediately of any additions to or deletions from the list of Users, or changes to Users’ level of access.
Ensuring that eviCore’s web-based applications are utilized only by authorized Users in accordance with their designated level of access.
Ensuring that each User has his or her own User ID number and PIN, password, or other security device, and that such information is kept confidential and not shared or displayed.
User Duties. Each User agrees to comply with all security rules concerning protection of information during transmission, viewing, and storage that are adopted and from time to time modified by eviCore, whether contained in this Access Agreement or a separate document. Additionally, each User agrees to the following:
To keep User ID numbers, PINs, passwords or other security devices confidential and available only to the assigned User. This information shall not be shared or displayed. User agrees to comply with all rules concerning the use of User ID numbers and security devices as provided by eviCore.
To not use automatic log on processes unless they require manual input of the User ID number, PIN, password, and/or other security device.
Not to save passwords in the system.
To employ reasonable means to ensure that the web-based information will not be visible to or accessible by the general public or any unauthorized viewers at any time.
To prevent unauthorized individuals from accessing or using eviCore’s web-based applications for any reason.
To access only information that User has a legitimate business need to know and to destroy any and all copies when no longer needed.
To the extent that User is authorized to enter or correct information in one of eviCore’s web-based applications, User acknowledges that he or she is authorized to make such changes and that eviCore has the right to make decisions based upon the accuracy of such information.
HIPAA/Confidentiality. eviCore’s web-based applications may contain individually identifiable health information and other confidential member information that is governed by state and federal law, including but not limited to the Health Insurance Portability and Accountability Act ("HIPAA"). User agrees that he or she is responsible for compliance with all applicable laws pertaining to the access to and use of this information. Any and all obligations contained in any agreement between Provider/Customer and eviCore that relate to confidentiality of information, by whatever name, shall apply to access and use of eviCore’s web-based applications by all Users.
No Warranty. eviCore makes commercially reasonable efforts to maintain the accuracy of information contained on its web-based applications. However, information sources are not always immediately current or subject to immediate verification. eviCore also reserves the right to shut the system down at any time for maintenance or otherwise as necessary.
THEREFORE, eviCore DOES NOT MAKE ANY REPRESENTATION OR WARRANTY, EITHER EXPRESS OR IMPLIED, THAT THE INFORMATION CONTAINED IN ITS WEB-BASED APPLICATIONS IS CORRECT OR ACCURATE, TIMELY, OR FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS. eviCore DOES NOT MAKE ANY REPRESENTATION OR WARRANTY, EITHER EXPRESS OR IMPLIED, THAT DEFECTS WILL BE CORRECTED OR THAT THE SYSTEM WILL ALWAYS BE ACCESSIBLE. eviCore MAY MAKE CHANGES AND/OR IMPROVEMENTS TO ITS WEBBASED APPLICATIONS AT ANY TIME, WITH OR WITHOUT NOTICE.
DISCLAIMER. eviCore’S WEB-BASED APPLICATIONS ARE PROVIDED ON AN "AS IS," "AS AVAILABLE" BASIS. eviCore, ON BEHALF OF ITSELF, ITS AFFILIATED COMPANIES, AND ITS OFFICERS, AGENTS, CONTRACTORS, AND EMPLOYEES, EXPRESSLY DISCLAIMS ALL WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NONINFRINGEMENT. eviCore DISCLAIMS ALL RESPONSIBILITY FOR ANY LOSS, INJURY, CLAIM, LIABILITY, OR DAMAGE OF ANY KIND RESULTING FROM, ARISING OUT OF, OR IN ANY WAY RELATED TO THE USE OR ACCESS, OR THE INABILITY TO USE OR ACCESS, THE WEB-BASED APPLICATIONS, REGARDLESS OF WHETHER SUCH DAMAGES ARE BASED UPON CONTRACT, STRICT LIABILITY, TORT, INTELLECTUAL PROPERTY LAW, OR OTHER THEORIES OF LIABILITY, AND ALSO REGARDLESS OF WHETHER eviCore WAS GIVEN ACTUAL OR CONSTRUCTIVE KNOWLEDGE THAT SUCH DAMAGES WERE POSSIBLE.
WITHOUT LIMITING THE FOREGOING, AND BY WAY OF EXAMPLE, eviCore SHALL NOT BE LIABLE FOR ANY VIRUS OR OTHER DAMAGE TO USER’S EQUIPMENT OR OTHER PROPERTY DUE TO USING OR ACCESSING THE WEB-BASED APPLICATIONS.
Intellectual Property Rights. Use of eviCore’s web-based applications does not transfer any rights of any kind to the User other than the limited right to access and use the information contained in eviCore’s web-based applications in accordance with this Access Agreement.
Cost of Access. Provider/Customer shall be solely responsible for the cost for any computer hardware and/or software necessary to access eviCore’s web-based applications. Provider/Customer shall also be responsible for the cost of providing access, including but not limited to charges for the ongoing use of telecommunications lines or internet service Provider/Customers. eviCore shall not be responsible in any way for any of these costs in the event that this Access Agreement is terminated or access to eviCore’s web-based applications, in whole or in part, is restricted or removed. Provider/Customer is responsible for ensuring that all hardware and software are compatible with eviCore’s web-based applications.
Remedies and Indemnity. User acknowledges that the information contained in eviCore’s web-based applications is a valuable and proprietary asset to eviCore and that the unauthorized use or disclosure of the information may cause eviCore irreparable harm. eviCore reserves the right to seek all remedies available at law or in equity for the unauthorized use or disclosure of information contained in its web-based applications or violations of the Access Agreement, including but not limited to terminating User’s access to the web-based applications, injunctive relief, and any other right or remedy available at law or in equity. Provider/Customer and/or User agree to indemnify and hold eviCore harmless for any loss, cost, or expense, including but not limited to reasonable attorney’s fees, directly related to a User’s improper use of a eviCore web-based application, access to confidential information, release of confidential information, or any other breach of this Access Agreement.
Unlawful Activity. eviCore reserves the right to investigate complaints or suspected violations of the access to or use of its web-based applications and to take any action eviCore considers appropriate, including but not limited to terminating Provider/Customer’s and/or User’s access to the web-based applications, and reporting suspected unlawful activity to law enforcement or other investigatory agencies and cooperating with them in the investigation of the suspected violation.
Audit Rights. eviCore reserves the right to audit or review any User’s access to its web-based applications, and to examine User’s system, hardware, and information, in any form, that was obtained from eviCore’s web-based applications. eviCore may conduct an audit during normal business hours on the premises where its web-based applications are accessed. User agrees to cooperate with such audit.
Obligations Following Termination. The provisions of paragraphs 7 and 12 regarding confidentiality and indemnity, respectively, shall survive the termination of this Access Agreement.
Entire Agreement. This Access Agreement incorporates by reference the Provider/Customer Agreement and any notices contained on this web-site and constitutes the entire agreement with respect to access to and use of eviCore’s web-based applications. If any of the terms of this Access Agreement is unlawful, void, or unenforceable, that provision shall be deemed severable from the remaining provisions and shall not affect their validity and enforceability. This Access Agreement shall be construed according to the laws of the state of Tennessee.
Conflict. If any of the provisions of the Provider/Customer Agreement or any notice conflicts with the terms of this Access Agreement, this Access Agreement shall govern the access to and use of eviCore’s web-based applications.
Modifications. eviCore reserves the right to change this Access Agreement at any time. Updated versions will appear on this web site and are effective immediately. User is responsible for regularly reviewing the Access Agreement. Continued access to eviCore’s web-based applications after any such change constitutes User’s consent to the change.
Please Select the Physician that you represent. A notification will be sent to the organization regarding this registration
Physician First Name:
Tax ID*:
Physician Last Name*:
Individual NPI*:
Physician will be notified of your user registration
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Please read below to sign up as an appropriate user.
Physician: An Individual Practitioner, A Medical Group Practice or an assistant of a Physician who would create and check status of a Pre-authorization.
Facility: Diagnostic Imaging Center, In-Office Provider (IOP), Hospital or Facility who would create and check status of a Pre-Authorization.
Billing Office: A billing Office who can check the status of Pre-Authorization, claims and payments. If you represent multiple Tax IDs, please register with your Primary Tax ID. You can tie additional preferred Tax Ids after your initial login.
Health Plan: A Health Plan representative who can check the status of Pre-Authorization and Claims.
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Registration Successful
Your Registration has been accepted. An email has been sent to your registered email account with registration details. Since you choose to validate via fax, a fax will be sent to you containing a security code. Please enter that code here.