VillageCareMAX uses evidence-based clinical guidelines from nationally recognized sources during review of organizational determinations for our Medicare products. VillageCareMAX utilizes InterQual guidelines as the evidence-based tool that supports clinical decision-making.
To review the guidelines utilized for a specific diagnosis or procedure, please access the following link:
InterQual® Criteria
*Registration is required to view the guidelines. Accounts are free and available to the public.
Members should consult their member-specific benefit plan document for information regarding covered benefits. As always, a member should discuss any medical concerns with their primary care provider.