Milliman care guidelines certification
[DOCX File]IN.gov | The Official Website of the State of Indiana
https://info.5y1.org/milliman-care-guidelines-certification_1_8809ac.html
The Contractor must be NCQA UM or URAC Health UM accredited within one year of operation. The Contractor will be required to use Milliman Care Guidelines for clinical standards of care determination. The Contractor must provide two licenses for the State’s use to access Milliman Care Guidelines directly. 4.2 . Administrative Structure
[DOC File]Re: - Michigan
https://info.5y1.org/milliman-care-guidelines-certification_1_42379f.html
The task for Long Term Care is Retrospective Appeals. The total is 41.66 hrs per month for RN, Annual total of 500 hours. The total is 20.83 hrs per month for MD, Annual total of 250 hours. Please identify if a national standard criteria is currently being used for inpatient and outpatient review, such as Milliman Care Guidelines.
Anthem
The company licenses and utilizes MCG™ (formerly known as Milliman Care Guidelines®) and may also license and/or utilize the guidelines of other entities. Prior Authorization Guidelines. ... Certification is required within forty-eight (48) hours or two (2) business days when a Covered Individual of our HMO plans or PPO programs with Managed ...
[DOC File]Specialty Appeal Letters
https://info.5y1.org/milliman-care-guidelines-certification_1_86c9bc.html
Cite Treating Physician’s Board Certification and/or specialty training ... Milliman and Roberts). Medical guidelines employed for medical decision-making must be flexible and allow for deviations from the guideline in order to incorporate the patient's unique medical factors. ... care should be taken to insert language that the clinical care ...
[DOCX File]Finding Your Lost Inpatients
https://info.5y1.org/milliman-care-guidelines-certification_1_550ab6.html
She says not to worry so much about InterQual criteria or Milliman’s care guidelines, neither of which does Medicare endorse. Instead, “just document the patient’s story in a way your mother would understand. Just tell why the person needs to be in the hospital . for medical reasons. for a couple of nights.”
[DOCX File]ATTACHMENT G: PRIOR AUTHORIZATION/UTILIZATION …
https://info.5y1.org/milliman-care-guidelines-certification_1_4cfe24.html
1.2Mandatory Requirement, Certification and/or Experience – Respondents must have experience providing Prior Authorization and or Utilization Management services for clients of similar size or characteristics to the State of Indiana Medicaid population. ... Describe how Respondent will utilize Milliman Care Guidelines. 2.13 Administrative ...
[DOC File]Anthem Blue Cross Blue Shield: Health Insurance, Medicare ...
https://info.5y1.org/milliman-care-guidelines-certification_1_bb28e5.html
The company licenses and utilizes MCG™ (formerly known as Milliman Care Guidelines®) and may also license and/or utilize the guidelines of other entities. Prior Authorization Guidelines. ... Certification is required within forty-eight (48) hours or two (2) business days when a Member of our HMO plans or PPO programs with Managed Benefits is ...
[DOC File]Anthem
https://info.5y1.org/milliman-care-guidelines-certification_1_ded8f3.html
The Milliman Care Guidelines® license includes (1) Inpatient and Surgical Care Guidelines, and (2) General Recovery Guidelines. Anthem also has the right to customize Milliman Care Guidelines® based on determinations by its Medical Policy & Technology Assessment Committee (“MPTAC”).
[DOC File]Insert Heading
https://info.5y1.org/milliman-care-guidelines-certification_1_1c7be9.html
Modify the system to ensure that claims received for the care select program require the certification code as appropriate. ... Monthly Milliman provider managed care file. Monthly Milliman provider group file. ... then they must have assignments based on eligibility and new guidelines for 07/01/2007.
[DOCX File]Welcome to the Network
https://info.5y1.org/milliman-care-guidelines-certification_1_327ab3.html
The suspension, revocation, expiration and/or voluntary surrender of professional license/certification, DEA certificate, CDS certificate, and/or board certification must be reported within 10 calendar days of the effective date of the action. ... MCG (formerly known as Milliman Care Guidelines), and the Centers for Medicare and Medicaid ...
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