Clinical Utilization Management Guidelines — New York Medicaid (DME-related listing)
A listing of Clinical Utilization Management (CUMG) guidelines adopted by Anthem for New York Medicaid, including numerous Durable Medical Equipment (DME) and other clinical guideline identifiers; governs medical necessity review and pre-payment review processes for Medicaid members in New York.
Clinical Utilization Management Guidelines — Scope & Index
This document is an index/listing of Clinical Utilization Management Guidelines (CUMGs) that Anthem has adopted for New York Medicaid. The CUMGs are used to guide medical necessity review, site-of-service appropriateness, inpatient level-of-care decisions, and outpatient services where no other policy exists. While external resources such as MCG Care Guidelines may be used to support utilization review, Medicaid contracts, CMS requirements and Anthem's own policies supersede external guidelines.
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