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Highmark transitions to MCG health clinical guidelines

Effective February 13, 2023, Highmark will incorporate MCG Health clinical guidelines into Highmark’s criteria of clinical decision support, replacing Change Healthcare (InterQual). This change is being made to align the clinical review processes and platforms for Highmark health plans.

As a reminder, you may view out-of-area Blue Plan’s general pre-certification/preauthorization information by visiting our Precertification/prior authorization provider page, which can be found here. For benefit information utilize Availity or call the number on the back of the member’s ID card.

If you have additional questions regarding the latest news article, please contact your BCBSKS provider representative.

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