Clinical Information to Establish Medical Necessity

eviCore will only approve requested tests or treatments if submitted medical records sufficiently establish medical necessity; requests lacking adequate documentation will not be approved. Required documentation includes a recent history and physical (virtual or in‑person), relevant labs, imaging, pathology and procedure reports, and other providers' notes, with additional case‑specific information requested as needed.

"Requests for tests or treatments submitted to eviCore for medical necessity review (eviCore applies an evidence-based approach to evaluate the most appropriate medically necessary care for each pat..."

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