Milliman level of care criteria
[DOC File]ERISA – Becoming An Authorized Representative
https://info.5y1.org/milliman-level-of-care-criteria_1_28798a.html
For example, many hospitals utilize Interqual for assessing length of stay and level of care. Physicians may utilize a specialty specific source for guidance on treatment plan development. These published industry standards should be cited in your medical necessity and prior authorization appeals to demonstrate that recognized quality care is ...
[DOCX File]Advocacy Action Network - Home
https://info.5y1.org/milliman-level-of-care-criteria_1_0453d1.html
The Contractor shall adopt Interqual or MCG (Milliman) as the primary medical/surgical criteria for Medical Necessity except that the Contractor shall utilize the American Society of Addiction Medicine (ASAM) for substance use.
[DOC File]Title 13--DEPARTMENT OF SOCIAL SERVICES
https://info.5y1.org/milliman-level-of-care-criteria_1_8ccfd2.html
A. Medical necessity at an inpatient hospital level-of-care; ... Milliman Care Guidelines includes adult and pediatric criteria for general medical care admissions; (B) Supplemental criteria sets are included for adult and child psychiatric care, rehabilitation care and alcohol/drug abuse treatment; ... review agent either by the CyberAccess ...
[DOC File]Appeal Letter Documentation
https://info.5y1.org/milliman-level-of-care-criteria_1_a1d08f.html
Internal Clinical Criteria For Treatment Plan Development ... For example, many hospitals utilize Interqual for assessing length of stay and level of care. Physicians may utilize a specialty specific source for guidance on treatment plan development. ... with the most widely used standard being Milliman & Robertson. The following interview ...
[DOCX File]Subject: - Home State Health
https://info.5y1.org/milliman-level-of-care-criteria_1_f1777a.html
A day of care that is, or appears to be, necessitated by quality of care issues or largely preventable issues [e.g., complication due to wrong medication dose, central line-associated blood stream infections (which can include PICC lines and both tunneled and non-tunneled central lines), ventriculitis or meningitis in a patient with a reservoir who is receiving taps in place of a shunt and who ...
Anthem Blue Cross Blue Shield: Health Insurance, Medicare ...
Milliman Care Guidelines® ... If master’s level degree does not meet criteria and practitioner obtained PhD training as a clinical psychologist, but is not licensed as such, the practitioner can be reviewed. To meet criteria this doctoral program must either be accredited …
[DOCX File]PRE-PROPOSAL CONFERENCE
https://info.5y1.org/milliman-level-of-care-criteria_1_1d0df0.html
What criteria are used to assign an initial length of stay for an inpatient admission (i.e., Milliman Care Guidelines, Interqual, proprietary guidelines, etc.)? Discuss your ability to coordinate the prior authorization with required or recommended decision support programs
[DOC File]State of Oklahoma - Oklahoma Health Care Authority
https://info.5y1.org/milliman-level-of-care-criteria_1_5ad85d.html
Medical homes receive a monthly care coordination fee for each member depending on the level of service they provide, categorized as Tier 1, 2, or 3. Oklahoma’s three Health Access Networks (HAN) provide additional services to medical homes, including care management of some groups, access to specialists, and assistance with health ...
[DOCX File]AR Systems, Inc
https://info.5y1.org/milliman-level-of-care-criteria_1_76282d.html
UHC uses Milliman Care Guidelines (MCG) to determine medical necessity and the appropriate level of care. She was also told: UHC will provide a copy of the MCG criteria upon request before, during or after a reconsideration request.
[DOC File]Re: - Michigan
https://info.5y1.org/milliman-level-of-care-criteria_1_fa9183.html
Please identify if a national standard criteria is currently being used for inpatient and outpatient review, such as Milliman Care Guidelines. Answer: InterQual® Criteria is currently utilized. 10.
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