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

  • We have been using American Health Holding for many years. From the relationship with our account executive to the quality of service provided, American Health is a knowledgeable and reliable partner.
    Thomas R. Daniel
    Administrator
    New Orleans Employers - International Longshoremen's Association New Orleans, LA
  • 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