MCG Care Guidelines

For select services, Highmark may use vendor guidelines. MCG care guidelines are licensed by Highmark and used to guide utilization management decisions. These decisions may involve, but are not limited to inpatient review, prior authorization, discharge planning, level of care, and retrospective review. Licenses include:

  • Ambulatory Care
  • Behavioral Health Care
  • General Recovery Care
  • Home Care
  • Inpatient & Surgical Care
  • Interrater Reliability
  • Recovery Facility Care
  • Medicare Compliance

*BY CLICKING THE LINK ABOVE YOU WILL BE LEAVING A HIGHMARK SITE. Highmark contracts with MCG to provide certain medical policies. Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark and/or third parties from whom Highmark has licensed the right to use such policies. Due to these third-party licensure restrictions, clinical guidelines can be accessed via a password protected site. Directions for obtaining a password to view the clinical guidelines are contained on the linked page. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use. Use of MCG’s site may require that you accept additional terms of use and/or privacy policies.  You acknowledge and agree that your use of MCG’s site is at your sole risk.