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Clinical Resources

Coverage Criteria & Guidelines
Find clinical criteria used to make medical necessity determinations for coverage of certain behavioral health services
Find clinical criteria used to make medical necessity determinations for coverage of certain medical and surgical services

Prior Authorization
Learn about prior authorization requirements and resources
Get information on prior authorization for behavioral health services
Find information on the chiropractic services authorization program
Learn about prior authorization for dental services
Learn about authorization requirements for genetic testing
Access resources and information for high-technology radiology services
Get information on authorizations for home health care services
Download InterQual®′ criteria and access SmartSheets
Find out about PT, OT, and speech therapy services and authorization requirements
Learn what to do to refer members for sleep management services

Clinical Programs & Information
Get information on case management and chronic condition management programs that we offer
Make the connection between oral & overall health
Access information, clinical guidelines, and other resources to care for your patients
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