Connecticut
Access to MCG™ Criteria
If you received a denial letter based on MCG™ (formerly known as Milliman Care Guidelines) criteria that says a link to MCG™ criteria is available online, you can access the MCG™ criteria at the link below. To access the MCG™ criteria, enter the following information from your denial letter:
- Date of letter
- Member’s last name
- MCG Guideline Code (stated in the letter)
- Password (stated in the letter)
Kentucky
To access our utilization review process, please click the link below:
Illinois
You may access the criteria we use to review services/procedures using the following links:
MCG™ (formerly known as Milliman Care Guidelines)
American Society of Addiction Medicine (ASAM)
Behavioral Health/Substance Use Disorder
For treatment of a child or adolescent mental disorder, reviews are based on the most recent guidelines of the American Academy of Child and Adolescent Psychiatry's Child and Adolescent Service Intensity Instrument
For the treatment of an adult mental disorder, reviews are based on the most recent Guidelines of the American Psychiatric Association
For treatment of a substance use disorder, reviews are based on the most recent edition of the American Society of Addiction Medicine's Patient Placement Criteria:
Required Precertification List
For a list of services/procedures requiring precertification, please click the link below.