Clinical Guidelines

This Clinical Guideline has been developed in accord with medical necessity criteria contained in Hawaii's Patients' Bill of Rights and Responsibilities Act (Hawaii Revised Statutes §432E-1.4), generally accepted standards of medical practice. If a treating physician disagrees with Evolent's determination as to medical necessity in a given case, the physician may request that HMSA reconsider the application of the medical necessity criteria to the case at issue in light of any supporting documentation.

Physical Medicine Solutions

Evolent adopted the use of MCG Guidelines® for its Physical Medicine product. View instructions for accessing MCG Guidelines®.

Medicaid Solutions

Evolent adopted the use of MCG Guidelines® for Indiana Medicaid members. View instructions for accessing MCG Guidelines®.

CMS Medicare Solutions

Evolent uses the Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) directly from CMS

Urgent Emergent Criteria

• Urgent Emergent Criteria