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Provider Criteria

Utilization Management Criteria

Medicare National and Local Coverage Determinations

https://www.cms.gov/medicare-coverage-database/indexes/national-and-local-indexes.aspx

Medicare Benefit Policy Manual

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS012673.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=ascending

Medicare Managed Care Manual

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019326.html?DLPage=2&DLEntries=10&DLSort=0&DLSortDir=ascending

Medical Policy of the Member’s Health Plan

Please contact Concerto at 1-877-597-1440 for details

MCG (Milliman Care Guidelines) current edition

Please contact Concerto at 1-877-597-1440 for details