Does Medicare use InterQual or Milliman?
Notably, the Centers for Medicare and Medicaid Services (CMS), has declined to adopt a proprietary decision support tool like Milliman or InterQual, hewing instead to a broader definition of medical necessity.
What are Milliman clinical guidelines?
The Milliman Care Guidelines span the continuum of patient care providing access to evidence-based knowledge and best practices relevant to patients in a broad range of care settings. This not only assists with decisions for each setting but also facilitates coordination of care and smooth patient transitions.
What is MCG insurance?
Please be advised that effective May 31, 2019, WellCare is adding the Milliman Clinical Guidelines (MCG) criteria for Medicare Inpatient Physical Health, Outpatient Physical Health, and Outpatient Behavioral Health Services. MCG Health's guidelines offer an evidence-based approach to the most cost effective care.
Is Milliman and MCG the same?
In November 2012, the New York-based Hearst Corporation acquired Milliman Care Guidelines, LLC, and our organization evolved into MCG Health.
What is Milliman or InterQual?
Acute inpatient hospitals use Milliman and InterQual criteria to help determine the appropriateness of care. Both sets of criteria are evidence-based screening tools used by providers and insurance companies. They do not substitute for the physician advisors' professional opinions when determining medical necessity.
What are the MCG guidelines?
MCG Care Guidelines are written to address the clinical circumstances of the majority of people. However, an individual's unique clinical circumstances will be considered in light of these policies and peer-reviewed, evidence-based scientific literature.
What is MCG and InterQual?
MCG focuses more on severity of illness and diagnosis. InterQual focuses more on intensity of service required and provides detailed day-by-day guidelines.