Medical Review Criteria for Managing Care®: Ambulatory

 The bible for health plan benefit interpretation guidelines.

 More than 2,000 detailed clinical review criteria guidelines and evidence-based benefit interpretations.

 Provides utilization management and claims departments with essential information to assist in medically-necessary benefit determinations.

 Includes specific indications for medically necessary ambulatory care or inpatient tests and procedures.

 Extensive literature references and other authoritative resources in each guideline, with web links.

 List of LOS benchmarks by DRG for Medicare, commercial and Medicaid populations.

Guidelines

  • INT - Introduction
  • AI - Allergy & Immunology
  • AN - Anesthesia
  • BB - Blood Products; Transfusion; Phlebotomy; Apheresis
  • CAR - Cardiology; Vasculitis
  • CVS - Cardiovascular and Peripheral Vascular Surgery
  • CAM - Complementary and Alternative Medicine
  • DER - Dermatology
  • DM - Disposable Medical Supplies (DMS) and Durable Medical Equipment (DME)
  • ED - Medical Education and Training