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Medical Policies
Medical guidelines used to make coverage decisions.
InterQual Clinical Criteria
InterQual® evidence-based clinical decision support criteria used to make medical necessity determinations.
Drug Policies
Drug policies assist in the administration of the pharmacy benefit.
Administrative Policies
A Health Plan policy that defines and outlines correct coding and payment guidelines.
Credentialing Policies
Guidelines for credentialing to determine qualifications, career history, education, training, licensure and certifications.
Clinical Editing Policies
Guidelines for the review of submitted claims, for appropriate coding and reimbursement.
Substance Use & Alcohol Treatment
Level of Care for Alcohol and Drug Treatment Referral (LOCADTR) clinical tool.
