This section is designed to assist you with the care delivery process. For member eligibility information, please log into our secured Provider Portal.
At-a-Glance
Clinical Practice Guidelines »
Preventive Screening Guide for Key HEDIS® Measures »
Interqual® Coverage Guidelines »
Your Plan may use Interqual® criteria to make coverage decisions. To review this criteria, click the link above. After you click the link, follow the steps on the screen to first create an account and then login to access Interqual® criteria.
Medical Policies and Clinical Guidelines »
Your Plan may also use Elevance medical policies and clinical guidelines accessible through our affiliated health plan, Simply Healthcare. Click the link above to review these guidelines.
Medicare MCG Coverage Guidelines »
Your plan may use MCG criteria to make coverage decisions. To review MCG criteria, click the link above to go to MCG’s tool. After you click the link, follow the steps on the screen to access MCG criteria.
Your Plan uses the internal coverage criteria above for Special Supplemental Benefits for the Chronically Ill (SSBCI).