Guidelines
Guidelines
Medical LOB
- Federal/State Mandates
- Benefit Coverage
- Health Plan Medical Policies
- Health Plan Clinical UM Guidelines
- Other Guideline Sets Adopted by Health Plan
- MCG
- Apollo Managed Care Guidelines
Commercial LOB
- Health Plan Medical Policy
- Applicable National Imaging Associates (NIA) Policies
- Applicable American Specialty Health (ASH) Policies
- MCG Guidelines
- MG/IPA Policy (HMO LOB Only)
Medicare LOB
- Medicare National Coverage Determination (NCD)
- Medicare Local Coverage Determination (LCD)
- CMS Benefit Policy Manual/Medicare Managed Care Manual
- Health Plan Medical Policy
- MCG Guidelines
- Apollo Guidelines
Dual Special Needs Plan (D-SNP) LOB
- Medicare Benefit Policy Manual
- Medicare National Coverage Determination (NCD)
- Medicare Local Coverage Determination (LCD)
- Non-LCD Medicare Administrative Contractor (MAC) (Noridian)
- Other Medicare Communications such as Medicare Learning Network Communications (MLN)
- MCG Guidelines Recognized Evidence-Based Criteria
- DHCS Medi-Cal UM Criteria
