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 phone and appointment access. We continually monitor our performance and measure our results annually. The results for 2024 are reported below.  

Prior authorization

Evernorth does not require prior authorization for:

• Emergency evaluation and stabilization services.
• Routine care with in-network  providers.

Phone access (to live person)

Customers and referring providers may call Evernorth for help obtaining behavioral care appointments with an in-network provider. In 2024, Evernorth continued to respond to 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 2024, we implemented interventions to address staff workloads and training, streamline recruitment and back-filling practices, and consolidate phone queues. The 2024 results are shown below.

• Provider phone access.  To help referring providers who call to find in-network behavioral providers for their patients, we strive to connect them with a live person in a timely manner. Our 2024 results are shown below.

To help improve these measures, and to meet the needs of customers and in-network providers, we continue to examine call volumes and staffing on a regular basis and make appropriate adjustments and improvements, as needed. Team leadership is also stepping in and covering phone queues during high call volume times.

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 2024 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 in-network  providers and facilities.
• Continuing expansion of telehealth services to the network.
• Continuing addition of ancillary and virtual programs to the network.
• Continuing implementation of the Evernorth Care Group.

Additional information

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

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