Medical necessity criteria updates to occur in July; include Milliman Care Guidelines
As you may know, Magellan uses Milliman Care Guidelines – in addition to our proprietary clinical criteria – as the primary decision support tools for our Utilization Management Program for commercial health plans. Collectively, they are known as the Magellan Care Guidelines.
The updated criteria set will become effective July 1, 2018. Stay tuned to our provider website, MagellanProvider.com, for its release.
Note that criteria for some levels of care, plans and states differ. Please visit our Medical Necessity Criteria webpage for more information.