The Apollo Managed Care Guidelines

 

Since 1997, Apollo Managed Care, Inc.’s publications the Apollo Medical Review Criteria & Guidelines and the Apollo Clinical Guidelines have been trusted resources for providing medical review criteria and guidelines that assist in identifying case management and treatment options that are appropriate and medically necessary. Apollo’s guidelines are 100% evidence-based. Apollo now combines its prior publications in the Apollo Managed Care Guidelines which is available through Apollo’s web portal.

Request Demo
health care 1

Apollo Managed Care Guidelines — Current Online Contents

  • Medical Review Criteria for Managing Care

    • The bible for health plan benefits 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.

           Read More

  • Acute Care Inpatient Review Criteria Guidelines

    • More than 350 guidelines that contain acute care inpatient review criteria with MS-DRG and APR-DRG Length of Stay data.
    • Evidence-based, with comprehensive reference links.
    • Provides utilization management and claims departments with essential information to assist in medically-necessary benefit determinations.
    • Includes a section entirely devoted to Managing Unplanned Readmissions, which includes issues, innovative programs, resources, and strategies needed to manage CMS targeted readmission diagnoses and avoid financial penalties.
    • Detailed review criteria by MS-DRG focus on medical necessity and appropriateness of care.
    • Search guidelines by DRG, CPT/HCPCS, ICD-9, or keyword.

            Read More

  • Managing Physical/Occupational/Speech Therapy & Rehabilitation Care

    • Detailed review criteria for adult/pediatric OT, PT, speech therapy plus therapy-related DME.
    • Detailed review criteria guidelines for inpatient rehabilitation unit/hospital admission, continued to stay, and discharge.
    •  The recommended number of visits required to treat specific conditions and instruct patients for self-directed home care.
    • Resources include example protocols and quality monitors throughout including the Oregon Pediatric guidelines for rehabilitation, websites.

            Read More

  • Post-Acute Care and Other Extended Care Services

    • Comprehensive policies, procedures, and plans for quality-based, cost-effective management strategies and review criteria for post-acute care in a subacute unit, SNF, institution, hospice, and/or the home under managed care contracts and Medicare.
    • Review criteria guidelines/benefit "interps".
    • Numerous forms and coverage information.
    • Extensive references.
    • Resources such as stroke, cardiac, and pulmonary rehabilitation guidelines.

            Read More

  • Managing Behavioral Health Care; Review Criteria, Care Management

    • Detailed behavioral health review criteria guidelines and benefit interpretations for inpatient and outpatient care by the diagnostic entities, including office visit edits.
    • Strategies for quality-based efficient delivery of integrated effective behavioral healthcare management.
    • Adult and children’s behavioral health LOS and CM.

            Read More

  • Disease State Management: Clinical Guidelines

    • Medical (asthma, COPD, diabetes, hypertension, smoking cessation, cardiovascular disease prevention, hormonal therapy) and obstetrical (LOS and the prevention of preterm deliveries) clinical guidelines plus “Wellness” or preventive healthcare standards by age and sex and Prevention of Stroke & CAD. Resources include related patient education, extensive references, and web links.

            Read More

  • Case or Care Management

    • Plans, policies, procedures, and strategies that work to improve the quality and efficiency of care while controlling costs for medical and mental health care.
    • This application is ideal for accreditation and quality improvement strategies.

            Read More