Provider materials and tools

Magellan Complete Care is licensed to use MCG Care Guidelines to guide utilization management decisions.

Utilization management decisions may include, but is not limited to:

  • Decisions involving pre-certification
  • Inpatient review, level of care
  • Discharge planning
  • Retrospective review

The MCG guidelines licensed include:

  • Inpatient & Surgical Care Guidelines
  • General Recovery Care Guidelines

Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law.

Clinical UM guidelines can be highly technical and complex, treating health care providers should discuss the information in the clinical UM guideline with their patients.

The MCG guidelines are proprietary and are not published online. If you would like to request a hard copy of an individual MCG guideline, please call us at 800-327-8613.