Frequently Asked Questions

Here is a list of our most commonly-Asked questions

Who uses Apollo Medical Review Criteria and Guidelines®?

Apollo medical review criteria are used in almost every state and Puerto Rico by: Health Plans, capitated medical groups, MSOs, provider networks, IPAs, behavioral health providers, medical school faculty, practice groups/plans, hospitals, PHOs, State and County Health Departments.

Additional users include: Review organizations, specialty networks, indemnity carriers, third party administrators, consultants, law firms, VA hospitals, U.S. Military, Indian Health Services, and Licensing boards.

How are the Apollo Medical Review Criteria and Guidelines® developed?

Apollo criteria have been developed by and under the direction of Margaret D. Bischel, MD, FACP. Contributors to the development process include many health plans and other entities that use Apollo criteria. All Apollo criteria and guidelines are evidence-based and supported by extensive current references in the peer-reviewed literature.

Are Apollo Medical Review Criteria and Guidelines® used by accredited medical organizations?

Apollo guidance have been reviewed by literally hundreds of utilization review/management committees for health plans, IPAs, and other health care organizations as is required for their accreditation by NCQA, URAC and other agencies. Blue Cross Blue Shield of Illinois has approved Apollo review criteria guidelines for use by its contracted medical groups and IPAs.

How does Apollo determine the Medicare and commercial carrier resources listed in each guideline?

A selection occurs from a pool of accredited carriers. When available, AHRQ, peer-reviewed medical literature and other resources for authoritative review articles are incorporated. Similarly, national guidelines from specialty organizations are cited. In most cases, a link to the original resources is listed for quick access by the reviewer.

How often are the Apollo guidelines updated?

The contents of Apollo guidance are reviewed and updated at least annually; updates and revisions of a single guideline occur more often if an important study is published in a peer-reviewed journal or a guideline released by an authoritative organization.

Do the Apollo Medical Review Criteria and Guidelines® include care guidelines?

Comprehensive care or clinical guidelines are available for pediatric, medical, obstetrical, mental or behavioral healthcare. The focus of Apollo's medical review criteria is coverage based on evidence-based medically necessary appropriate care.

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