EviCore has launched proprietary DME guidelines designed to keep pace with evolving clinical evidence and make resources more accessible to providers.
Why we made this change
Previously, we used third-party DME guidelines, which limited our flexibility. Updates only happened about twice each year, and health plans often had to separately purchase guideline access for appeals, adding cost and complexity.
What’s better now
- More frequent updates: Updates to our proprietary guidelines can happen more frequently—at least quarterly, and sometimes more often as new clinical evidence emerges or coding changes occur. This means the criteria you’re working with will stay current with the latest standards of care.
- Free, direct access: Full DME guidelines are available directly on EviCore’s portal resource page at no additional cost.
- Clinical oversight: EviCore Medical Directors are actively involved in developing and refining these guidelines, ensuring they maintain alignment with current clinical standards.
- Proactive EIU code review: Experimental, Investigational, and/or Unproven (EIU) HCPCS codes are regularly evaluated as new data emerges to help ensure the guidelines remain current and evidence-based, even for emerging technologies and treatments.
Good news for your workflow: We performed a comprehensive gap analysis during this transition and found no significant differences between the previous third-party standards and EviCore’s new guidelines. Your existing knowledge and processes should translate seamlessly.
If you have any questions regarding the new DME guidelines, please contact your Provider Engagement Manager.