Clinical Information to Establish Medical Necessity

Tests or treatments are only approved if legible, sufficiently detailed clinical records are submitted to establish medical necessity—required documentation commonly includes a recent history and physical (virtual or in‑person), lab results, imaging, pathology and procedure reports, and reports from other treating providers—and requests with missing, insufficient, or unreadable records will be denied.

"eviCore applies an evidence-based approach to evaluate the most appropriate medically necessary care for each patient."

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