Policy Updates Medical Policy & Clinical GuidelinesCommercialApril 30, 2024

MCG Care Guidelines 28th edition

Effective September 1, 2024, Anthem will upgrade to the 28th edition of MCG Care Guidelines for the following modules. Below is high level summary of the updates and is not intended to be all inclusive:

  • Behavioral Health Care (BHG):
    • The goal length of stay (GLOS) has been changed in two guidelines in the 28th edition of Behavioral Health Care.
  • Inpatient & Surgical Care (ISC):
    • The goal length of stay (GLOS) has been changed in a total of 72 Optimal Recovery Guidelines in the 28th edition of Inpatient & Surgical Care. In medical Optimal Recovery Guidelines, the GLOS has been changed in 37 guidelines, and the GLOS has been changed in 35 surgical Optimal Recovery Guidelines in the 28th edition of Inpatient & Surgical Care.
  • General Recovery Care (GRG):
    • Benchmark length of stay (BLOS) has been refined in the 28th edition of General Recovery Care.
  • Recovery Facility Care (RFC):
    • A total of one guideline has been removed from the 28th edition of Recovery Facility Care.
  • Chronic Care (CCG):
    • A total of 10 guidelines have been moved in the 28th edition of Chronic Care.

If you have questions, please contact the provider service number on the back of the member's ID card.

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: June 2024 Provider Newsletter