EviCore Healthcare is a company specializing in healthcare management solutions, primarily focusing on improving the quality and efficiency of medical care. The company operates in the healthcare sector, serving a diverse range of clients including patients, healthcare providers, and insurance payers. EviCore's primary market includes the United States, where it works closely with Medicare and Medicaid services, as well as private health plans.

EviCore's business model revolves around providing evidence-based care guidelines and managing healthcare utilization. This means they use scientific research and data to create guidelines that help doctors and patients decide on the best treatment options. They also manage how healthcare services are used to ensure that patients receive necessary and effective treatments without unnecessary procedures.

The company makes money by partnering with health plans and insurance companies to manage their healthcare services. They offer a range of services including prior authorization (getting approval before certain medical services are provided), decision support (helping doctors make informed treatment decisions), case management (coordinating care for patients with complex needs), and payment integrity (ensuring that payments for healthcare services are accurate and fair).

EviCore is well-prepared for new regulations from the Centers for Medicare & Medicaid Services (CMS) aimed at improving the prior authorization process. This readiness positions them as a reliable partner for healthcare providers and payers looking to comply with these new rules.

In summary, EviCore Healthcare is a key player in the healthcare management industry, offering services that enhance the quality and efficiency of medical care through evidence-based guidelines and effective utilization management.

Keywords: healthcare management, evidence-based care, prior authorization, decision support, case management, payment integrity, Medicare, Medicaid, health plans, utilization management.