Laboratory Management

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There may be instances in which your health plan policies take precedence over the EviCore by Evernorth clinical guidelines. If you have any questions, please reach out to your health plan.

Follow the below steps to access the clinical guidelines.

Enter your Health Plan name into the search field and click on the magnifying glass.
To access the guideline specific to your request, locate the guideline that the decision was based on from within your letter.
Identify the guideline title and then search for that guideline title by scrolling down on the page or entering the guideline title into the guideline title search field.
Open the guideline document.

Example:

The statement in your letter reads:

We based this decision on the guideline as listed below:
-MTHFR Variant Analysis for Hyperhomocysteinemia (MOL.TX.205).

Enter your Health Plan name into the search field and click on the magnifying glass.

Enter the guideline title into the search field for the guideline name.

Once the search results appear, click on the guideline to open it.

If you require a copy of the guidelines that were used to make a determination on a specific request of treatment or services, please email the case number and request to: reqcriteria@EviCore.com.

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EviCore coverage policies include background and supporting information and citations for sources used to develop the policy. Some clinical policies may have a supplemental literature summary available which will provide additional commentary regarding clinical benefits and harms to the patient population being served. Additional literature summaries may be accessed by selecting ‘Supplemental Information’ and then entering “EviCore by Evernorth” in the search by health plan function.