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EviCore Guidelines Navigator

Search and browse EviCore clinical guidelines, prior authorization requirements, and utilization management policies. Access evidence-based criteria for specific conditions and procedures, understand documentation requirements, and identify which payers apply EviCore guidelines to your technology. Polify provides full transparency into EviCore criteria alongside commercial payer medical policies.

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EviCore Guidelines Navigator

Search and browse clinical guidelines, prior authorization requirements, and utilization management policies

Important Information About Prior Authorization

Prior authorization requirements can create barriers to care. Recent investigations have found that benefit management companies like eViCore may deny medically necessary care, with high rates of overturned denials upon appeal. This tool provides transparency into eViCore's guidelines, but does not endorse their policies. We recommend documenting all interactions and appealing inappropriate denials.

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Search by guideline title, keywords, procedure, or diagnosis...
Prior Authorization

Find procedures requiring prior authorization and submission requirements

Clinical Guidelines

Access evidence-based guidelines for specific conditions and procedures

intelliPath ePA

Learn about electronic prior authorization integration with EHR systems

Found 5 results

MRI Brain
Clinical GuidelineID: RAD-001

This guideline addresses the use of MRI of the brain for various clinical indications. It outlines the appropriate use criteria based on symptoms, diagnoses, and prior imaging results.

Updated: 07-09-2023RadiologyAetna, Cigna, UnitedHealthcare
Cardiac CT and CCTA
Authorization RequirementID: CARD-002

This guideline outlines the prior authorization requirements for Cardiac CT and Coronary CT Angiography (CCTA). It specifies the clinical scenarios where these studies are considered medically necessary.

Updated: 08-14-2023CardiologyAetna, Blue Cross Blue Shield, UnitedHealthcare
Lumbar Spine Surgery
Utilization ManagementID: MSK-003

This guideline addresses the utilization management criteria for lumbar spine surgeries including discectomy, laminectomy, and fusion procedures. It outlines the clinical scenarios where surgical intervention is considered medically necessary.

Updated: 09-04-2023MusculoskeletalCigna, UnitedHealthcare, Blue Cross Blue Shield, Humana
PET/CT for Oncologic Indications
Clinical GuidelineID: ONCO-004

This guideline addresses the appropriate use of PET/CT imaging for cancer diagnosis, staging, restaging, and treatment response assessment across various cancer types.

Updated: 07-31-2023Medical OncologyAetna, Cigna, UnitedHealthcare, Blue Cross Blue Shield, Humana
CPAP and BiPAP Therapy
Documentation RequirementID: SLEEP-005

This guideline outlines the documentation requirements for Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP) therapy for obstructive sleep apnea and other related breathing disorders.

Updated: 10-14-2023Sleep ManagementAetna, UnitedHealthcare, Blue Cross Blue Shield

Prior Authorization Criteria

Identify every procedure requiring prior authorization under EviCore guidelines. Understand submission requirements, clinical criteria, and documentation needed to support authorization requests.

Clinical Guidelines by Specialty

Browse evidence-based clinical guidelines organized by specialty and payer. Filter by guideline type, last updated date, and the specific payers that apply each guideline to their members.

intelliPath ePA Integration

Learn how EviCore intelliPath enables electronic prior authorization directly within EHR workflows. Understand integration requirements and how to streamline the authorization process for your technology.