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Medical Necessity Criteria

 

To determine whether an intervention or service requested is the most appropriate treatment available, ConnectCare's utilization management department uses InterQual to provide nationally recognized, well researched clinical criteria. When necessary, internal criteria is developed in order to remain current with effective treatment modalities, and also to ensure that enrollees have equitable access to safe and effective care. ConnectCare evaluates and updates these criteria with a review of updated medical literature. This document is a list of the internally developed criteria for the following ConnectCare employer groups:

  • MidMichigan Health
  • Northwood University
  • Three Rivers Corporation

ConnectCare

Utilization Management

ConnectCare's Utilization Management Staff is available to address questions and issues related to case management and utilization by using the telephone or fax numbers listed below.

ConnectCare Medical Management
4000 Wellness Drive
Midland, MI 48670
Toll free: 888-646-2429
Local: 989-839-1613
Fax: 989-839-1679
 
Hours of Operation
8:00 a.m. - 12:00 p.m.
1:00 p.m. - 5:00 p.m.
Monday - Friday (Eastern Time)

After normal business hours, inbound communications and information may be relayed via fax, confidential voice mail or electronic mail. All precertification requests and/or communications received after normal business hours are returned on the next business day and communications received after midnight on Monday through Friday are responded to on the same business day.

Certified by NCQA since 2007

NCQA Certified Utilization Management"Achieving Utilization Management Certification from NCQA demonstrates that ConnectCare has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards." -- Margaret E. O'Kane, President, NCQA

NCQA has reviewed and certified ConnectCare's Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.