Cencalhealth Coverage Criteria
Latest Cencalhealth coverage criteria updates5
- Coverage CriteriaClinical/Medical PolicyEff. 2024-01-01Utilization Review - Prior Authorization, Concurrent Review, and Retrospective ReviewThis policy governs CenCal Health's prior authorization, concurrent review, and retrospective review processes for determining the medical necessity, coverage, and appropriate amount, duration, and scope of health care services.All cencalhealth updates
- Coverage CriteriaClinical/Medical PolicyEff. 2018-05-01Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary CareThis policy governs annual alcohol misuse screening, behavioral counseling, and referral processes for CenCal Health members age 18 and older in primary care. It also addresses referrals for alcohol use disorder or co-occurring mental health needs, documentation, billing, and care coordination.All cencalhealth updates
- Coverage CriteriaClinical/Medical PolicyEff. 2011-02-01Clinical Criteria for Utilization Management Authorization DecisionsGoverns the development, adoption, application, review, revision, and disclosure of clinical criteria used for prospective, concurrent, and retrospective utilization review for Medi-Cal and D-SNP members.All cencalhealth updates
- Coverage CriteriaClinical/Medical PolicyEff. 2011-02-01Clinical Criteria for Utilization Management Authorization DecisionsGoverns the development, adoption, application, review, revision, and distribution of clinical criteria used for prospective, concurrent, and retrospective utilization review of Medi-Cal services.All cencalhealth updates
- Coverage CriteriaClinical/Medical PolicyAuthorization Guidelines for Hearing AidsThis policy governs CenCal Health authorization, medical-necessity documentation, coding, and submission requirements for hearing aids, replacements, repairs, programmable or digital systems, and related supplies or accessories.All cencalhealth updates
Tool Description
Search Cencalhealth coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
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Coverage policies are updated every day. Follow payer coverage policy updates in the live policy feed, or browse all CPT, HCPCS and DRG billing codes.
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