Clinical Information to Determine Medical Necessity

Approval is contingent on submitted medical records demonstrating medical necessity per eviCore's evidence-based review; requests without sufficient or pertinent documentation (or missing required elements) will not be approved. Required documentation includes a recent detailed history and physical, relevant labs, imaging, pathology and procedure reports, and reports from other treating providers (the list is not exhaustive).

"Requests for tests or treatments where medical necessity is being evaluated by eviCore using an evidence-based approach."

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