EviCore by Evernorth is a medical benefits management company. As an outsourced medical review company, it reviews prior authorizations for medical procedures on behalf of insurance companies and Medicaid programs, which it then approves or denies. It also issues medical guidelines, which doctors have described as inappropriately delaying and denying medical care for patients. Medical organizations that have criticized EviCore's guidelines include the American College of Cardiology, the Society for Vascular Surgery, and ASTRO.
EviCore offers its services via several types of contracts. One is a risk contract, in which EviCore is responsible for keeping the costs for a particular type of medical procedure (for example, MRIs) below a certain threshold. If they are successful, they get paid from their savings. They also provide flat rate contracts.
In February 2024, EviCore was fined $16,000 by Connecticut's Insurance Department after a review of 196 files.
The company was founded as MedSolutions Inc in 1992.
In 2016, EviCore acquired QPID Health Inc.
In 2017, Express Scripts acquired EviCore for $3.6 billion. In 2018, Express Scripts was acquired by Cigna.
References
- ^ Miller, T. Christian; Rucker, Patrick; Armstrong, David (October 23, 2024). "Inside the Company Helping America's Biggest Health Insurers Deny Coverage for Treatments". ProPublica.
- O'Donnell, Carl (2017-05-04). "Exclusive: Health benefits manager eviCore explores sale, IPO - sources". Reuters.
- "EviCore Healthcare Health". The Wall Street Journal. 2016-02-27.
- Bomey, Nathan. "Express Scripts buys medical benefits management firm eviCore for $3.6 billion". USA TODAY.