Clinical Information to Establish Medical Necessity

eviCore will approve requests for medical necessity (e.g., prior authorization or utilization review) only when legible, sufficiently detailed medical records are provided and will deny requests if required documentation is missing, illegible, or lacks clinical detail. Required documentation includes a recent virtual or in‑person evaluation with detailed history and physical, pertinent laboratory, imaging, pathology and procedure reports, and reports from other treating providers.

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

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