Clinical Information to Establish Medical Necessity

eviCore will approve tests or treatments it reviews for medical necessity only when the provider submits legible, pertinent medical records (including a recent clinical evaluation with detailed history and physical, labs, imaging, pathology, procedure reports, and reports from other treating providers); requests with insufficient or unreadable records will not be approved. The listed documentation elements are commonly required but not exhaustive, so additional information may be requested.

"Requests for a test or treatment being reviewed by eviCore that require a medical necessity determination (i."

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