The ASAM Criteria®
Evernorth uses The ASAM Criteria, developed by the American Society of Addiction Medicine (ASAM), for guidance in conducting medical necessity reviews of substance use disorder levels of care for all health plan business, unless contractual requirements and/or federal or state law require use of other specifically identified clinical criteria.
| Document Title | Document Type | Last Updated |
|---|---|---|
| The ASAM Criteria, 3rd Edition Evernorth uses The ASAM Criteria, 3rd Edition to conduct substance use level of care medical necessity reviews for all customers 17 years and under, unless contractual requirements and/or federal or state law require the use of other specifically identified clinical criteria. |
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| An Introduction to The ASAM Criteria® for Patients and Families (3rd Edition) The ASAM Criteria, 3rd Edition (full guidelines) Instructions to access educational criteria training for providers (developed by ASAM 3rd Edition) Educational criteria training for customers (developed by ASAM) |
PDF Online Resource |
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| Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. |
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| The ASAM Criteria, 4th Edition Beginning in November 2024, Evernorth will use The ASAM Criteria, 4th Edition to conduct substance use level of care medical necessity reviews for all customers for 18 years and older, unless contractual requirements and/or federal or state law require the use of other specifically identified clinical criteria. |
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| Introduction to The ASAM Criteria for Patients and Families (4th Edition) The ASAM Criteria, 4th Edition (full guidelines) Instructions to access educational criteria training for providers (developed by ASAM 4th Edition) Educational criteria training for customers (developed by ASAM) will be posted when available. |
PDF -- |
11/06/2024 11/06/2024 11/06/2024 11/06/2024 |
| Copyright 2024 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. |