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

• Click here to view Evolent’s Physical Medicine guidelines.
• 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®.

Radiation Oncology

To access Evolent’s Clinical Guidelines and Coding Standards, Please click here: Capital Blue Cross - Radiation Oncology 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