05/20/2024
Blue Cross and Blue Shield of Texas uses some, but not all, clinical criteria from MCG Care Guidelines when reviewing requests to determine medical necessity. Our clinical rationale outlined in some provider correspondence and in some Clinical Payment and Coding Policies will guide you to the specific MCG Care Guidelines, when applicable.
As a helpful resource, you can now access MCG guidelines through your Availity Essentials login.
How to access MCG Guidelines through Availity
- Log onto Availity Essentials
- Select on Payer Spaces on the upper navigation bar
- Select BCBSTX to navigate to our payer space
- Select the Resources tab
- Select MCG Guidelines and then follow the prompts
Search for related MCG Guidelines by opening any category link and searching for services by name and topic using the “control + F” key board function.
Remember: BCBSTX does not rely on all MCG Care Guidelines to support our utilization management decision making.
MCG Care Guidelines are administered and provided by MCG Health, an independent company that has contracted with Blue Cross and Blue Shield of Texas to provide care and disease management for members with coverage through BCBSTX.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.