Durable Medical Equipment

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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.

If you would like to view all EviCore core guidelines, please type in "EviCore by Evernorth" as 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.
Review the reason for denial from the letter you received.
Identify the guideline title from the letter you received and then search for that guideline title by scrolling down on the page.
Open the guideline that returns in the search results.

Example:

The reason for denial states in your letter states: This decision was based on your health plan’s policy called EviCore Durable Medical Equipment (DME) Guidelines).

Enter your Health Plan name into the search field and click on the magnifying glass, then click on the corresponding guideline to open the guideline document (example: Durable Medical Equipment (DME) Guidelines).

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.

To request any additional assistance in accessing the guidelines, provide feedback or clinical evidence related to the evidence-based guidelines, please click here.