Nova Pathfinder Clinical Guidelines
Medical and Pharmacy Clinical Guidelines describe Nova Pathfinder’s evaluation of medical procedures, devices, and medications.
These materials are used to guide utilization management decisions. The specific care and treatment ordered by your provider may vary, depending on individual needs. Clinical guidelines are approved and adopted by the Nova Pathfinder insurance company and Nova Pathfinder Limited (collectively, “Nova”). These include internally developed Nova Clinical Guidelines, guidelines licensed from third parties, technology reports licensed from third parties, criteria licensed from CVS/Caremark, national society guidelines (e.g., NCCN, ACOG), and other evidence-based resources. Clinical guidelines are evaluated and updated at least annually.
Clinical guidelines are complex and intended for use by healthcare professionals. They are not intended to provide medical advice or medical care. Medical advice and medical care should be discussed with the treating provider. Nova Pathfinder Clinical Guidelines help us determine medical necessity, but do not guarantee benefit coverage.
Coverage is subject to the terms and conditions of your policy and applicable state and federal law. To confirm benefit coverage or to request a copy of a clinical guideline used to support medical necessity decisions, please contact Member or Provider Services: 833-444-6682 for Nova Pathfinder plans.