UM Criteria
Utilization Management (UM) Policies & Procedures, as well as the UM Criteria used to authorize healthcare services, will be made available upon request.
Modify or deny healthcare services will be made available upon request to providers, members, their designated representatives, and the general public. The staff at My Family Medical Group accepts collect calls related to UM issues during normal business hours.
Clinical Criteria for UM Decisions
Application of Evidence Based Criteria
Download the official clinical criteria document used to support evidence-based utilization management decisions and medical necessity reviews.
Medical Necessity Review
MFMG uses MCG to aid in clinical decision making regarding utilization management.
MCG is a nationally recognized clinical decision support tool used to guide evidence-based medical necessity determinations.
MFMG uses MCG Guidelines to help review medical necessity for health service requests. MCG Guidelines are the protected intellectual property of MCG. MFMG is not able to distribute them without the permission of MCG. MCG has provided a tool that allows MFMG members and prospective members to view relevant MCG Guidelines. However, you will not be able to print them.
Follow the instructions below for access to MCG Guidelines.
Access Instructions
Click the button above to access the MCG Guidelines. Read the disclaimer and accept the Terms and Conditions.
Complete the User Information Form.
Complete the verification process (CAPTCHA) to continue.
Click on the arrow icon to expand a guideline product.
Click on the guidelines you wish to view.
Note: Guideline sessions automatically time out after 5 minutes of inactivity.
Medical Necessity Supplementation Criteria
Evidence-based criteria by service category.
View Medical Necessity Supplementation Criteria organized by service category. Documents are presented in an easy-to-browse index and are available as in-browser PDF files for convenient access across desktop and mobile devices.