Guideline Updates Coverage and Clinical GuidelinesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsMay 30, 2024

MCG Care Guidelines 28th edition

Effective September 1, 2024, HealthKeepers, Inc. 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):
    • The 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 any questions, please contact the Provider Services number on the back of the member's ID card.

HealthKeepers, Inc. is an independent licensee of the Blue Cross Blue Shield Association. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: July 2024 Provider Newsletter