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)

 

Access the MCG criteria

 

Kentucky

To access our utilization review process, please click the link below:

Utilization Review Process

 

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:


ASAM Criteria.pdf


Required Precertification List

For a list of services/procedures requiring precertification, please click the link below.

Precertification List

Testimonials

  • American Health Holding has been a valued partner for over 12 years. We find them to be very helpful and responsive, especially working with their Case Management department.
    Patty Darrow
    RN, BSN, CCM
    Leggett & Platt Carthage, MO
  • American Health Holding is always looking at ways to innovate and offers each client the opportunity to customize a program that fits their unique needs. Their specialized medical professionals combine compassion, patience and unique knowledge about health care navigation to support the member and plan from both a quality of care and cost perspective.
    Holly Weiske
    Director of Client Services
    Cypress Benefit Administrators Appleton, WI
  • American Health has provided a great resource with their ability to assist with RFP and sales opportunities. They are always willing to customize materials and programs to best fit our clients' and prospects' needs.
    Bill Bixler
    Sr. Account Executive
    The Loomis Company Wyomissing, PA
  • I have been very impressed with American Health's client support. If one person is out I can call someone else who is always willing to assist. This is extremely helpful to our case management and medical review needs.
    Jeannie Couey

    BAS Limited Ridgeland, MS