Evolent Partnership

Date: 06/21/24

Ambetter of Tennessee has partnered with Evolent (formerly New Century Health) to implement a new prior authorization program. Evolent is a comprehensive Cardiology Quality Management Company. This program is intended to help providers easily and effectively deliver quality patient care.

Effective September 1, 2024, invasive cardiology procedures and services will require prior authorization through Evolent prior to being rendered in a physician’s office, outpatient hospital, ambulatory, or inpatient setting (planned professional services only.

Ambetter of Tennessee authorizations issued before September 1, 2024, will be effective until the authorization end date. This prior authorization management program will apply to your Ambetter of Tennessee (Exchange) members 18 years of age and older.

The Evolent program will apply to all specialties for the following invasive cardiovascular services:

• Cardiac catheterization and intervention
• Electrophysiology
• Vascular radiology and intervention
• Cardiac surgery
• Vascular surgery

Prior authorization requests for invasive cardiology services can be submitted to Evolent:

• Evolent provider portal (CarePro) my.newcenturyhealth.com.
• Via telephone at 1.888.999.7713, cardiology (option 1). Staff is available Monday -Saturday from 8:00 a.m. to 8:00 p.m. EST.

Evolent uses clinical criteria based on nationally recognized guidelines to promote evidence-based practices. When using Evolent’s CarePro provider portal, you will be able to:

• Obtain real-time approvals when selecting evidence-based treatment care pathways.
• Determine the clinical documentation required for medical necessity review.
• View all submitted requests.
• Request to speak with clinicians to discuss treatment options.

Ambetter of Tennessee is proud to be your healthcare partner. If you frequently request cardiology services and are new to this process, Evolent representatives will contact you soon to schedule an introductory meeting and in-service training.

If you have questions about the Evolent cardiology services program, please email providertraining@evolent.com or call 1.888.999.7713, (option 1).

We look forward to collaborating with you.