Highmark has selected MCG Health, part of the Hearst Health network and an industry leader in evidence-based guidance, as our acceptable use criteria vendor to review utilization management (UM) requests beginning February 2023.
Highmark’s transition from Change Healthcare (InterQual) to MCG will more fully support our Living Health strategy and allow us to upgrade our UM capabilities and automation.
MCG is known in the industry as an independent publisher of clinical decision support widely used by both payers and providers alike (nine of the largest U.S. health plans as well as nearly 2,600 hospitals). Working from a common clinical language, Highmark hopes to enhance communication and reduce payer-provider abrasion.
Highmark will work with MCG’s education support team to develop training for providers and their staff members. More information will be shared with you as it becomes available.
While the vendor for acceptable use criteria may be changing, the overall process for how Highmark’s nurses and medical directors review and decision authorization requests will not change.