The 28th edition of MCG’s Care Guidelines will be available on Aug. 1, 2024.

After that date, you will be able to submit authorization requests using the 28th edition for any new requests. Any authorization requests with a start of care date prior to Aug. 1, 2024, will be reviewed using the 27th edition.

We began incorporating clinical guidelines from MCG Health into our criteria of clinical support decisions in February 2023. This change has allowed us to enhance visibility to utilization management criteria while simplifying the authorization process for providers.

Please continue to use the Predictal application in Availity^® to submit authorization requests with clinical information included.

Providers can view a summary of changes for the 28th edition from their MCG site.

Questions

Contact Highmark Clinical Services or the Provider Service Center with any questions. Phone numbers for each region may be found in the Quick Reference Guide.