Alliance uses the NCDHHS Clinical Coverage Policies for utilization management. Where the medical necessity criteria are not specified or defined in the NCDHHS Clinical Coverage Policies, or where NCDHHS does not have a policy, Alliance will use MCG Health criteria as permitted by NCDHHS. If neither of these sources provides guidance, Alliance develops its own Medical Policies.
Alliance Medical Policies are evidence-based documents that detail the medical necessity criteria of given procedures or technologies. They are used to assist in administering health plan benefits and to establish consistency for coverage and efficiencies in the clinical decision-making process.
The following Medical Policies have been reviewed and adopted by Allianceās Medical Policy Committee.
