Blue Cross and Blue Shield of Illinois uses some, but not all, clinical criteria from MCG Care Guidelines when reviewing requests to determine medical necessity. Our clinical rationale outlined in some provider correspondence and in some Clinical Payment and Coding Policies will guide you to the specific MCG Care Guidelines, when applicable.
As a helpful resource, you can access MCG Care Guidelines through your Availity Essentials login.
How to access MCG Care Guidelines through Availity:
- Log on to Availity Essentials;
- Select Payer Spaces in the upper navigation bar
- Select the BCBSIL tile to navigate to our payer space;
- Select the Resources tab;
- Select MCG Guidelines and then follow the prompts.
Remember: BCBSIL doesn’t rely on all MCG Care Guidelines to support our utilization management decision making. You may search for related MCG Care Guidelines by opening any category link and searching for services by name and topic using the “control F” keyboard function.
MCG Care Guidelines are administered and provided by MCG Health, an independent company that has contracted with BCBSIL to provide care and disease management for members with coverage through BCBSIL. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.
This content is for informational and educational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with BCBSIL. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment.