CMS Fully Qualifies eviCore’s Clinical Decision Support Mechanism

BLUFFTON, S.C. — July 27, 2017 — eviCore healthcare (eviCore), a leader in evidence-based health benefit management services, announced that it was among only seven clinical decision support mechanisms (CDSMs) recently receiving full qualification from the Centers for Medicare & Medicaid Services (CMS). eviCore and the Medical Guidelines Institute (MGI), which received approval from CMS as a qualified provider-led entity (PLE), have agreed to collaborate to incorporate MGI's appropriate use criteria (AUC) into eviCore CDSM.


As part of efforts to ensure that Medicare patients receive appropriate, cost-effective care, CMS is mandating the use of CDSMs for outpatient diagnostic imaging. Starting in January 2019, physicians must consult AUC when ordering advanced imaging procedures such as CT, MRI, and PET for designated conditions. Providers who implement the use of a CDSM earlier will earn points under the 2018 Merit-based Incentive Payment System (MIPS).


"eviCore has more than 25 years of experience developing best practices and tools, including our CDSM, that help improve quality and ensure appropriate resource use for advanced imaging, as well as many other healthcare services," said John J. Arlotta, chairman and CEO of eviCore. "We are grateful for the opportunity CMS has created for entities like ours to help ensure the safety and quality of care for Medicare beneficiaries."


eviCore's CDSM is fully integrated with many popular electronic health record systems, including Cerner, Epic, Meditech and Allscripts. In addition to AUC from MGI, eviCore's tool incorporates a broad set of guidelines across its supported clinical domains for enterprise-wide deployment, and it has been used in a wide range of coverage models.


eviCore also works in collaboration with MGI, which was approved by CMS as a qualified PLE. MGI, a non-profit corporation established in 2015, works to deploy comprehensive, evidence-based AUC. MGI's provider leadership is composed of physicians practicing at some of the nation's most prestigious academic institutions and hospital systems and includes a partnership with physicians associated with Banner Health, an Arizona-based nonprofit health system.


"Comprehensive, evidence-based AUC are the foundation for ensuring higher-quality care for Medicare beneficiaries, and we're delighted to collaborate with MGI in its efforts to deliver criteria that are not only robust and scientifically sound but also easy for clinicians to use," said Dr. Norman Scarborough, eviCore's senior vice president of medical affairs and chief of radiology services.. "I continue to be impressed by the breadth and depth of experience brought to the table by the physicians on the MGI AUC-development team, who combine evidence-based rigor with their daily experience caring for patients to develop guidelines that really make a difference." ​


About eviCore healthcare
eviCore healthcare (eviCore) offers proven, diversified medical benefits management solutions that help clients reduce costs while increasing quality of care for their members. The company provides these solutions to managed care organizations and risk-bearing provider organizations serving commercial, Medicare, and Medicaid populations. Powered by a team of specialized medical professional resources, extensive evidence-based guidelines, and advanced technologies, eviCore supports clients by ensuring the right evidence-based care is delivered at the right time to the right patient at the right site of care. Flexible medical benefits management solutions are offered in: Radiology; Cardiology; Musculoskeletal; Medical Oncology; Radiation Therapy; Specialty Drug Management; Sleep; Lab Management; and Post-Acute Care. eviCore is proud to help 100 million members receive higher quality, lower cost healthcare. For more information, please visit