Search Results For : " UNIVERSITY OF BIRMINGHAMBIRMIN "
Provider Resources - Utilization Management Criteria
e. IEHP has created UM Subcommittee Approved Authorization Guidelines to serve as one of the sets of criteria for medical necessity decisions. Our goal in creating this page is to provide you with easily accessible electronic versions of IEHP’s UM guidelines. IEHP utilizes a variety of sources in developing our UM guidelines which include:
Medicare and Medi-Cal’s coverage policy statements
Evidence in the peer-reviewed published medical literature
Technology assessments and structured evidence reviews
Evidence-based consensus statements
Expert opinions of healthcare Providers
Evidence-based guidelines from nationally recognized professional healthcare organizations and public health agencies.
IEHP is also licensed to use MCG Guidelines, Apollo Medical Review Criteria, and InterQual to guide in utilization management decisions.
Since medical technology is constantly evolving, our clinical guidelines are subject to change without prior notification. Additional UM Subcommittee Guidelines may be developed as needed or may be withdrawn from use.
Please note that benefits may vary based on Member’s line of business; therefore, certain services discussed in the UM Subcommittee Guidelines may not be a covered benefit.
Table of Contents (PDF)
Providers may obtain information about criteria, either in general or relating to specific UM decisions, from IEHP upon request by contacting the IEHP UM Department. Please contact the IEHP Provider Relations Team at (909) 890-2054 to be connected to the UM Department.
Behavioral Health
Behavioral Health Treatment (BHT) Criteria (PDF)
Criteria for Multidisciplinary Diagnostic Treatment (PDF)
Community Supports Services
Community Transition Services Nursing Facility Transition to a Home (PDF)
Nursing Facility Transition-Diversion to Assisted Living (PDF)
Housing Deposits (PDF)
Housing Transition Navigation Services (PDF)
Housing Tenancy and Sustaining Services (PDF)
Asthma Remediation (PDF)
Environmental Accessibility Adaptations (Home Modifications) (PDF)
Medically Tailored Meals (PDF)
Sobering Centers (PDF)
Recuperative Care (PDF)
Short-Term Post-Hospitalization Housing (PDF)
Day Habilitation Programs (PDF)
Respite Services (PDF)
Personal Care and Homemaker Services (PDF)
Diagnostic Testing
Elastography (PDF)
Inflammatory Bowel Disease Serology (PDF)
Vestibular Autorotation Test (PDF)
Gynecology and Obstetrics
Fetal Non-Stress Testing (PDF)
Neurology
Bone Marrow Transplant in Treatment of Multiple Sclerosis (PDF)
Pain Management
Referrals to Pain Management Specialist (PDF)
Pharmacy
Biosimilar Products (PDF)
CAR-T Therapy (PDF)
Surgical Procedures
Adolescent Bariatric Consultation and Surgery (PDF)
Natural Orifice Transluminal Endoscopic Surgery (PDF)
Other
Allocation of Limited Critical Care Resources During a Public Health Emergency (PDF)
Complementary and Alternative Medicine or Holistic Therapies (PDF)
Congregate Living Health Facilities (PDF)
Criteria for Custodial Care: Medi-Cal (PDF)
Enhanced Care Management (PDF)
Hair Removal Guideline (PDF)
My Path (A Palliative Care Approach) (PDF)
Tertiary Care Center Referral Requests (PDF)
Transitional Care Medicine (PDF)
Transportation Criteria (PDF)
You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Upcoming Events - Becoming a Mom: You and Your Pregnancy (San Bernardino)
Upcoming Events - Healthy Heart (Online): Knowledge is Power + React in Time to Heart Attack Signs (Online)
l understand how the heart works and lifestyle changes for a healthy heart. We will also be discussing early signs of a heart attack and how to prevent a heart attack.
Click here to register for this Webex class
Session Number: 26310238435
Download Webex for Apple users
Download Webex for Android users
Download Webex for PC users
Upcoming Events - Healthy Heart : Get Energized! Say Yes to Physical Activity + Control Your Blood Pressure (Riverside)
Upcoming Events - Healthy Heart (Online): Knowledge is Power + React in Time to Heart Attack Signs (Online)
derstand how the heart works and lifestyle changes for a healthy heart. We will also be discussing early signs of a heart attack and how to prevent a heart attack.
Click here to register for this Webex class
Session Number: 26328620505
Download Webex for Apple users
Download Webex for Android users
Download Webex for PC users
Upcoming Events - Healthy Heart (Online): Get Energized! Say Yes to Physical Activity + Control Your Blood Pressure (Online)
Upcoming Events - Becoming a Mom: You and Your Pregnancy (Victorville)
Upcoming Events - Healthy Heart (Online): Get Energized! Say Yes to Physical Activity + Control Your Blood Pressure (Online)
Upcoming Events - Understanding Diabetes: Problem Solving (Riverside)
Upcoming Events - Eat Healthy, Be Active Workshop (Victorville)
Upcoming Events - Understanding Diabetes (Online)
Upcoming Events - Healthy Heart : Knowledge is Power + React in Time to Heart Attack Signs (San Bernardino)
nderstand how the heart works and lifestyle changes for a healthy heart. We will also be discussing early signs of a heart attack and how to prevent a heart attack.
Click here to register for this in-person class
Location
IEHP Community Resource Center (San Bernardino)
805 W 2nd St
San Bernardino, CA 92410
Upcoming Events - Becoming a Mom: You and Your Pregnancy (San Bernardino)
Upcoming Events - Healthy Heart : Knowledge is Power + React in Time to Heart Attack Signs (San Bernardino)
l understand how the heart works and lifestyle changes for a healthy heart. We will also be discussing early signs of a heart attack and how to prevent a heart attack.
Click here to register for this in-person class
Location
IEHP Community Resource Center (San Bernardino)
805 W 2nd St
San Bernardino, CA 92410