Medical Necessity Criteria

To determine whether an intervention or service requested is the most appropriate treatment available, ConnectCare's utilization management department uses InterQual to provide nationally recognized, well researched clinical criteria. When necessary, internal criteria is developed in order to remain current with effective treatment modalities, and also to ensure that enrollees have equitable access to safe and effective care. ConnectCare evaluates and updates these criteria with a review of updated medical literature. This document is a list of the internally developed criteria for the following ConnectCare employer groups:

• MyMichigan Health
• Northwood University