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| Utilization Management Guidelines (UMGs) | |
BlueCross BlueShield of Tennessee (BCBST) uses the Utilization Management Guidelines (UMGs) as part of the clinical decision process. The UMGs can be developed by BlueCross BlueShield of Tennessee to supplement the MCG Care Guidelines when a MCG or Medical Policy does not exist. MCG Care Guidelines can be modified due to a BCBST business decision or when the goal length of stay needs to be defined or when consideration is given to prevailing practice or evidence. The BCBST UMGs are reviewed annually or if an inquiry is received.
The following UMGs have been changed from MCG™, MCG Health, LLC has neither reviewed nor approved the UMGs. Any statement to the contrary or association of the changed material with MCG Health, LLC is strictly prohibited. If you wish to view the complete MCG™, please contact MCG Health, LLC.
Utilization Management Guidelines (UMGs):
Goal Length of Stay Changes (e.g., ambulatory goal length of stay changed to 23-hr observation)
- Bone Excision
- Cesarean Birth
- Laminectomy with Rhizotomy
- Observation Goal Length of Stays
- Thoracic Surgery and/or Pulmonary Disease Intensive Care Admission
- Vaginal Birth
- Vaginal Birth, Operative
Listed Alphabetically:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z (view entire list)
Listed by Conditions:
Additional Listings:
- Ambulatory Care
- Behavioral Health
- General Recovery Guidelines
- Home Care
- Hospice Care
- Inpatient and Surgical Care
- Recovery Facility Care
- Line of Business Specific Guidelines
This document has been classified as public information.