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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.
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.
Find procedures requiring prior authorization and submission requirements
Access evidence-based guidelines for specific conditions and procedures
Learn about electronic prior authorization integration with EHR systems
Found 5 results
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.
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.
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.
This guideline addresses the appropriate use of PET/CT imaging for cancer diagnosis, staging, restaging, and treatment response assessment across various cancer types.
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.
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.