Medical Policies & Clinical UM Guidelines

The coverage policy includes pre-certification, inpatient review, discharge planning, and retrospective reviews guided by MCG clinical UM guidelines. However, coverage is subject to the specific terms and conditions of the benefit plan, which may result in exclusions or local variations and may not cover all services outlined in the guidelines. It is crucial for members to review their benefit plans for specifics on coverage and limitations.

"Coverage decisions may include pre-certification, inpatient review, level of care, discharge planning, and retrospective review based on clinical UM guidelines."

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