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Medical guidelines used to make coverage decisions.

InterQual^® evidence-based clinical decision support criteria used to make medical necessity determinations.

Drug policies assist in the administration of the pharmacy benefit.

A Health Plan policy that defines and outlines correct coding and payment guidelines.

Guidelines for credentialing to determine qualifications, career history, education, training, licensure and certifications.

Guidelines for the review of submitted claims, for appropriate coding and reimbursement. 

Guidelines for determining the correct level of care for substance use disorder treatment.