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Milliman Care Guidelines Milliman Care Guidelines Milliman Care Guidelines

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Managed Care 101: Utilization Management

Managed Care 101: Utilization Management

www.apg.org

• Milliman Care Guidelines (MCG) Slide 16. Proactive Mechanics of UM • Administrative procedures • Procedures as determined by benefit plan and payor – Discharge planning (from both acute and long term care facilities) – Concurrent review planning – Pre-certification

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Care Management Institute Guidelines - AAMCN

Care Management Institute Guidelines - AAMCN

www.aamcn.org

Proficiency in CMS Guidelines, Milliman & InterQual care guidelines, & Standards set by Children’s Health Insurance Program (CHIP) and TRICARE (previously called CHAMPUS: HMO-like Program with low cost-sharing for civilian medical services provided to active-duty and retired military personnel and their dependents)

  Guidelines, Care, Care guidelines, Milliman

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