Standards And Guidelines Medical Necessity Criteria
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CIGNA STANDARDS AND GUIDELINES/MEDICAL …
www.cigna.comASAM Criteria for Substance Use Disorders and developed our Standards and Guidelines - Medical Necessity Criteria for Treatment of Mental Health Disorders. These Criteria are intended to be working documents to help set expectations and facilitate a shared responsibility.
2020-2021 NIA Clinical Guidelines for Medical Necessity …
www1.radmd.comGuidelines for Clinical Review Determination Preamble Magellan is committed to the philosophy of supporting safe and effective treatment for patients. The medical necessity criteria that follow are guidelines for the provision of diagnostic imaging. These criteria are designed to guide both providers and reviewers to the most
Magellan Healthcare, Inc.* 2021 2022 Magellan Care Guidelines
www.magellanprovider.com2021 – 2022 Magellan Care Guidelines 3 Preamble - Principles of Medical Necessity Determinations Magellan uses MCG Guidelines®, along with its proprietary clinical criteria, Magellan Healthcare Guidelines, as the primary decision support tools for our Utilization Management Program.
Clinical Appropriateness Guidelines: Advanced Imaging
aimspecialtyhealth.com“Guidelines”) are designed to assist providers in making the most appropriate treatment decision for a specific clinical condition for an individual. As used by AIM, the Guidelines establish objective and evidence-based, where possible, criteria for medical necessity determinations. In the process, multiple functions are accomplished:
CLINICAL APPROPRIATENESS GUIDELINES
aimspecialtyhealth.com“Guidelines”) are designed to assist providers in making the most appropriate treatment decision for a specific clinical condition for an individual. As used by AIM, the Guidelines establish objective and evidence-based criteria for medical necessity determinations where possible. In the process, multiple functions are accomplished:
Medical Necessity Criteria
www.bcbsm.comMedical 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,
Speech-Language Pathology Medical Review Guidelines
www.asha.orgSpeech-Language Pathology Medical Review Guidelines 3 Introduction The purpose of the medical review guidelines for speech-language pathology is to serve as a resource for health plans to use in all facets of claims review and policy development. The guidelines provide an overview of the profession of speech-language pathology including
Medically Necessary Orthodontic Treatment – Dental ...
www.uhcprovider.comIn accordance with Generally Accepted Standards of Medical Practice. Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for your sickness, injury, mental illness, substance use disorder, disease or its symptoms. Not mainly for your convenience or that of your doctor or other health care ...