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
