Prior Authorization Guidelines & Criteria

Prior Authorization Guidelines & Criteria

Prior Authorization Guidelines
Medical/Dental Covered Services Prior Authorization Requirements
(Effective 11/01/2017).

Prior Authorization Criteria

Care1st uses clinically sound, nationally developed and accepted criteria for making medical necessity decisions. Clinical criteria utilized in decision making include, but is not limited to:

  • Milliman Care Guidelines
  • American College of Obstetrics and Gynecology
  • The American Academy of Pediatrics
  • Official Disability Guidelines (ODG)
  • Care1st Guidelines
  • ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, 3rd edition


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