A newsletter for the Highmark Blue Shield providers in central Pennsylvania, the Lehigh Valley, northeastern Pennsylvania and southeastern Pennsylvania
Issue 9, September 2023
The 27th edition of MCG’s Care Guidelines will be available on October 2, 2023.
After that date, you will be able to submit authorization requests using the 27th edition for any new requests. Any authorization requests with a start of care date prior to October 2, 2023, will be reviewed using the 26th edition.
We began incorporating clinical guidelines from MCG Health into our criteria of clinical support decisions in February 2023, replacing Change Healthcare (InterQual®). This change allows us to enhance visibility to utilization management criteria while simplifying the authorization process for providers. Click here
to learn more about this transition.
Please continue to use the “Authorization Submission” function in NaviNet® to submit requests with clinical information included.
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.
