Clinical Information to Establish Medical Necessity

eviCore will only approve authorization requests for tests or treatments if the provider submits legible, detailed medical records establishing medical necessity; incomplete or illegible records mean the request cannot be approved. Required documentation includes a recent virtual or in-person history and physical, relevant labs, imaging, pathology and procedure reports, and reports from other treating providers, and absence of these elements may result in denial.

"Requests for evaluation of medical necessity for tests or treatments submitted to eviCore."

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