Medical Review Criteria for Managing Care

• 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