Musculoskeletal: Advanced Procedures
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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 “reason for denial” section found in your letter.
- Identify the guideline title and/or number, then search for that guideline by scrolling down on the page. (You may also enter the guideline title into the guideline title search field).
- Open the desired guideline by clicking on it.
- Access the specific guideline section, if cited by scrolling to the table of contents and clicking on the section mentioned in your letter.
The reason for denial states in your letter states: Based on eviCore Comprehensive Musculoskeletal Management Guideline CMM 312 - Knee Surgery-Arthroscopic and Open Procedures (type of surgery to your knee).
Enter your Health Plan name into the search field and click on the magnifying glass. Locate the guideline by name, then click on the corresponding guideline to open the guideline document (example: CMM-312: knee Surgery- Arthroscopic and Open Procedures).
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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