Evernorth^® Behavioral Health (Evernorth) is committed to providing you with the resources and support you need to address your patients’ behavioral health requirements. Our up-to-date Behavioral Health Clinical Practice Guidelines are designed to enhance your clinical decision-making. 

Where our guidelines come from

To ensure our practices align with national standards and reflect the latest recommendations, Evernorth regularly adopts evidence-based clinical guidelines for behavioral health conditions from leading organizations, including:

• American Psychiatric Association
• American Academy of Pediatrics
• Canadian Psychiatric Association
• National Institute on Alcohol and Alcoholism
• Centers for Disease Control and Prevention
• American Society of Addiction Medicine

Before adopting any guidelines, we verify their alignment with MCG^® Behavioral Health Guidelines to ensure our standards are both rigorous and relevant. We conduct a formal review and update our guidelines at least every two years, but if new evidence or national standards emerge, we act even sooner to keep you up to date.

How we share updates

To keep you informed about the latest guidelines, we provide updates through various channels:

• Annual emailed or mailed communications.
• Letters to new providers.
• Online resources like our Behavioral Administrative Guidelines and the Provider Newsroom.

Medical necessity criteria and prior authorization

Our Behavioral Quality Committee reviews and approves medical necessity criteria using evidence-based methods that align with our clinical practice guidelines. In processing prior authorization requests, we use:

• MCG Behavioral Health Guidelines
• The ASAM Criteria^®
• LOCUS¹ and CALOCUS-CASII²
• Our coverage policies
• State regulations

We evaluate each request individually, taking into consideration the availability of services in your local area. For more information, be sure to check our Prior Authorization and Billing Resource Guide and Evernorth Medical Necessity Criteria.

If you ever have questions or need clarification, our team is here to help.

1  Level of Care Utilization System.

2  Child and Adolescent Level of Care/Service Intensity Utilization Instrument.