Disclaimer
VCHCP Medical Management utilizes Milliman Care Guidelines in addition to below Plan specific Medical Policies.
Medical Policies
Express Scripts Drug Policies – Medical Benefit
Milliman Care Guidelines (MCG)
Due to proprietary reasons, we are unable to post the Milliman Care Guidelines on our website, but a hard copy of an individual guideline can be provided as requested.
VCHCP Custom Drug Policies – Medical Benefit
Related Policies and Procedures
Drug Policies
- Coverage of Prescription Medication for Off-Label Use
- Pain Management for Terminally Ill Patients
- Prior Authorization of Medications
Utilization Management
- Utilization Management Program Description
- Direct Specialty Referral
- Emergency Services: Retrospective Authorization
- Independent Medical Review
- Medical Policy Development and Application of Criteria in Utilization Management
- Outpatient Observation versus Inpatient and Midnight Rule
- Out of Area Dialysis Services
- Second Opinions
- Standing Referrals to Specialists
- Treatment Authorization Request: Authorization Process and Timeline Standards
Behavioral Health Related Policies
Best Practice Guidelines
Level of Care Guidelines
Quality Assurance
- Quality Management Program Description
- Clinical Practice Guidelines
- Diabetes and Asthma Clinical Practice Guidelines
- Potential Quality Issues (PQI)
- Preventive Clinical Practice Guidelines
Grievance and Appeals
Continuity of Care
