Clinical Info for Medical Necessity
Clinical Guidelines

Clinical Info for Medical Necessity recently upgraded and some of your bookmarked Clinical Guidelines might have changed. Please ensure you are navigating to our most recent EviCore Clinical Guidelines.

Please note:

Adobe PDF Reader is required to view clinical guideline documents.

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.

  1. Enter your Health Plan name into the search field and click on the magnifying glass.
  2. To access the guideline specific to your request, locate the “reason for denial” section found in your letter.
  3. 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 name search field.
  4. Open that guideline, and scroll to the table of contents.
  5. Click on the section mentioned in your letter.


The reason for denial states in your letter states: Based on EviCore Neck Imaging Guidelines Section: NECK 9.1 Imaging, we cannot approve this request.

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: Neck Imaging Guidelines).

Once the guideline opens, scroll down to the table of contents page and select the appropriate guideline section noted in the denial reason (example: Neck 9: Trachea and Bronchus).

If there are multiple subsections, click on the corresponding subsection (example: Neck-9.1: Trachea and bronchus – Imaging).

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:

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