Clinical Information to Establish Medical Necessity

Approval of tests or treatments is contingent on submission of legible, pertinent medical records that establish current clinical status and medical necessity; requests with insufficient or illegible records will be denied. Required documentation includes a recent detailed history and physical (virtual or in‑person), relevant laboratory and imaging studies, pathology and procedure reports, and reports from other treating providers, and failure to provide these elements prevents approval.

"Legible medical records pertinent to the test or treatment being requested by the provider."

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