Medical Necessity Criteria - Blue Cross Blue Shield of ...
Medical Necessity Please refer to the controlling specific health plan and/or group documents for the definition of Medical Necessity. An internal New Directions committee of behavioral health practitioners and psychiatrists developed the Medical Necessity Criteria (“Criteria” or “MNC”) contained in this document. A panel of external,
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www.magellanprovider.comEach criteria set within each level of care category is a more detailed elaboration of the above definition for the purposes of establishing medical necessity for these health care services. Particular rules in each criteria set apply in guiding a provider or reviewer to a medically