Evernorth^® Behavioral Health (Evernorth) is committed to helping customers access behavioral care when they need it. To support these efforts, we have established standards regarding timeliness in the areas of telephone access and appointment access. We continually monitor our performance and measure our results annually. The results for 2023 are reported below.  

Prior authorization

Evernorth does not require prior authorization for:

• Emergency evaluation and stabilization services.
• Routine care with Evernorth-participating providers.

Telephone access (to live person)

Customers and referring providers may call Evernorth for help obtaining behavioral care appointments with a participating provider. In 2023, Evernorth continued to respond to access calls using a centrally managed, national call-answering team. To improve staff availability, we used different phone lines for health care providers/facilities and customers.

• Customer telephone access. To help customers find and receive care quickly and efficiently, we strive to connect them with a live person in a timely manner. In 2023, we implemented interventions to address staff workloads, staff training, and streamline recruitment and hiring practices. The 2023 results are shown below.

• Provider telephone access.  To help referring providers who call to find participating behavioral providers for their patients, we strive to connect them with a live person in a timely manner. Our 2023 results are shown below.

To help improve these measures, and to meet the needs of customers and participating providers, we continue to examine call volumes and staffing on a regular basis and make appropriate adjustments and improvements, as needed.

Appointment access (timeliness)

Evernorth categorizes appointment access standards that are consistent with the urgency of a customer’s perceived need and in alignment with industry standards. Each year, we conduct a satisfaction survey with all customers who access care to measure our performance in each category. The 2023 results are shown below.

Steps we are taking to improve access to care

To help improve our customers’ access to care, we are:

• Implementing action plans to address those measures that were reduced or did not meet the goal.
• Introducing a directory accuracy project to validate accurate information for network-participating providers and facilities.
• Continuing expansion of telehealth services to the network.
• Continuing addition of ancillary and virtual programs to the network.
• Implementing the Evernorth Care Group.

Additional information

For more information, refer to the Evernorth Behavioral Health Administrative Guidelines (see Provider participation, Scheduling Appointments, page 61).

If you have any questions or to share feedback, please contact Provider Services at 800.926.2273.