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Learn more about how Alliance is using technology to make prior authorizations more efficient per the CMS-0057-F rule.

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Clinical Resources

Find valuable information here about Clinical Practice Guidelines (CPGs), Clinical Coverage Policies (CCPs), In-Lieu-of Service Definitions (ILO), and more.

Alliance Health is dedicated to our mission to improve the health and well-being of the people we serve by ensuring highly effective, community-based support and care. To support this mission and to reduce variance in services delivered, we have adopted Clinical Practice Guidelines (CPGs), Clinical Coverage Policies (CCPs) and In-Lieu-of Service Definitions (ILO) which reflect the current professional standards of care.

While these policies are intended to inform, they are not intended to replace a physician’s clinical judgment. The physician remains responsible for determining the applicable treatment for each individual.

To learn more about our Clinical Coverage Policies and how to submit a Prior Authorization Request, please visit one of the following resource links below:

Clinical Coverage Policy Reference Tool

NC Medicaid and NC Health Choice Clinical Coverage Policies for Utilization Management. Where medical necessity criteria is not specific or defined in the NC DHHS Clinical Coverage Policies, or where NCDHHS does not have a policy, Alliance will use Clinical Coverage Policy approved by Alliance and MCG Health or InterQual criteria, as permitted by NCDHHS.

Alliance Behavioral Health Clinical Guidelines

Alliance’s approved Clinical Practice Guidelines and Psychological Testing Guidelines document what is known and what is not known about a condition or disorder for the treatment of patients with the ultimate goal of improving care.

Procedure Code Lookup

We are working on a service code lookup tool so that providers can see which service codes require prior authorization.

Prior Authorization Submission Process

This page provides guidance concerning the prior authorization submission process.