Providers

We treat every one of our more than 100M lives with an evidence-based, patient-sensitive approach that simplifies the MBM process for providers — and delivers the solutions that benefit everyone.

  

Clinical Guidelines

Please select clinical guidelines by first selecting the appropriate solution. Adobe PDF Reader is required to view clinical guideline documents.


Benefits, coverage policies, and eligibility issues pertaining to each health plan may take precedence over eviCore’s clinical guidelines. Select the view more option to access health plan-specific guidelines.

+ View more for health plan specific radiology guidelines

  • Aetna Nuclear Medicine Criteria
  • Aetna Radiology Criteria
  • Aetna Medical Clinical Policy Bulletins
  • Afinity
  • Alameda Alliance for Health
  • Avera Health Plan
  • BCBS AL

+ View more Physician Worksheets

  • Aetna Nuclear Medicine Criteria
  • Aetna Radiology Criteria
  • Aetna Medical Clinical Policy Bulletins
  • Afinity
  • Alameda Alliance for Health
  • Avera Health Plan
  • BCBS AL

Quick Reference Tool

Select the member’s health plan and solution in the dropdowns below to access the appropriate contact phone and fax numbers as well as the legacy portal used to initiate a case request online.

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To Create a Case

Contact Details

Online Forms & Resources

RESULTS FOR:

Forms & Resources

+ View more for health plan specific radiology guidelines

  • Aetna Nuclear Medicine Criteria
  • Aetna Radiology Criteria
  • Aetna Medical Clinical Policy Bulletins
  • Afinity
  • Alameda Alliance for Health
  • Avera Health Plan
  • BCBS AL

Solutions: Connecting the dots between everyone

eviCore brings together the broadest range of integrated, innovative medical benefits management solutions across the entire healthcare continuum, enabling better outcomes for our patients, providers, and plans​.

Specialty Solutions

  • Musculoskeletal

    Delivers a comprehensive suite of musculoskeletal solutions that focuses on a patient-centered approach.

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  • Pediatric Musculoskeletal Solution
  • Radiology

    Decreases the use of unwarranted tests and exposure to unnecessary radiation.

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  • Radiation Therapy

    Optimizes patient outcomes by assessing a patient’s specific disease state, stage, and treatment goals.

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  • Medical Benefits Management
  • Cardiology

    Decreases the utilization of inappropriate cardiac imaging tests, diagnostic services, and implantable devices.

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  • Medical Oncology

    Utilizes disease-specific algorithms to optimize clinical and financial outcomes through clinically appropriate treatment.

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  • Sleep

    Lowers costs and improves patient outcomes by analyzing patient’s therapy use and basing interventions on the results​.

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  • Post-Acute Care

    Helps patients receive the right care in the right setting after a hospital stay to improve health outcomes and lower cost.

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  • Lab Management

    Ensures appropriate utilization of genetic testing through clinical policy, medical necessity review, & claims payment rules.

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  • Health Benefit Plans
  • Specialty Drug Management

    Employs evidence-based guidelines to ensure appropriate use, drives drug administration, and ensures payment integrity.

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Market Solutions

  • Provider

    Ensures providers meet their financial objective while acting as an extension of their model.

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  • Health Plan

    Bringing value to the health plan; utilizing evidence-based tools; & engaging providers to contain costs and improve health.

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  • Government

    Provides specialty solutions to the government marketplace.

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  • eviCore Healthcare Solutions
  

Video Tutorials

  • eviCore Provider Login
  • Contacting us when you need us is easy.