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There may be instances in which your health plan policies take precedence over the eviCore healthcare 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 healthcare" 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.
- To access the guideline specific to your request, locate the “reason for denial” section found in your letter.
- Identify the guideline title and then open that guideline.
- Scroll to the table of contents page and select the guideline section mentioned your letter.
The reason for denial states in your letter states: Based on eviCore Sleep Disorders Diagnosis & Treatment Guidelines Section: SL 2.2 In-Laboratory Polysomnography- OSA Indications, 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: Sleep Disorders Diagnosis & Treatment).
Once the guideline opens, scroll down to the table of contents page and select the appropriate guideline section noted in the denial reason (example: SL 2.2 Indications/Diagnostic Testing).
Click on the corresponding subsection (example: SL2.2: In-Laboratory Polysomnography- OSA Indications).
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.