BCBSGa adopts Milliman Care Guidelines for inpatient rehabilitation, subacute rehabilitation and skilled nursing facility clinical reviews

Effective for dates of service on and after Oct. 31, 2018, BCBSGa will transition from using the InterQual (IQ) LOC: Rehabilitation and LOC: Subacute/SNF guidelines to using Milliman Care Guideline (MCG) Recovery Facility Care guidelines to review prior authorization requests for inpatient rehabilitation and skilled nursing facility services.

 

In addition, BCBSGa will transition from using the Interqual (IQ) LOC: Home Care to using Anthem Clinical UM Guidelines CG-MED-23 Home Health, CG-REHAB-04 Physical Therapy, CG-REHAB-05 Occupational Therapy or CG-REHAB-06 Speech-Language Pathology Services.

 

Detailed prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at Availity.com. Contracted and non-contracted providers who are unable to access Availity may call our Provider Services at the number on the back of the member’s ID card for prior authorization requirements.