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BLUECONNECT
Providers
September 2023
In This Issue
► September news: Executive summary
► Commercial plans transition to MCG care guidelines
► We're streamlining our 2024 HMO product options
► Secondary code edits implementing in November
► Learn + earn credits: Lifestyle medicine and nutrition
Take our Stigma-Free AZ pledge
Coming soon! MCG clinical guidelines for AZ Blue commercial plans
Blue Cross® Blue Shield® of Arizona (AZ Blue) is expanding its partnership with MCG Health (also known as “MCG”). Currently, we use MCG care guidelines (if there is no applicable NCD or LCD) for Medicare Advantage utilization management (UM). 

On November 1, 2023, we will begin using MCG in our clinical reviews for commercial plans as well. This will replace the InterQual® guidelines we currently use for commercial group and individual/family plans. 
Making it easy
Our transition to an expanded use of the MCG care guidelines will help streamline our UM operations across multiple lines of business and make it easier for you to service our members in alignment with our medical necessity determination guidelines.
This will assist AZ Blue in:
• Collaborating with network providers: Working from a common clinical language, MCG supports payer-provider communication and partnership in delivering care to patients.
• Optimizing evidence-based care: MCG criteria include thousands of references to medical literature that support appropriate, evidence-based clinical decision-making. MCG updates this content annually as scientific evidence evolves, ensuring guidance for best-practice care and optimal outcomes for patients and their families.
•
 Providing online access for providers: MCG offers a user-friendly web-based tool, Cite for Guideline Transparency, making it easy for providers to use the MCG care guidelines.
We'll begin using MCG on November 1
Please note that beginning November 1, 2023, we will use MCG care guidelines (instead of InterQual) for clinical reviews.  

We will be in touch with more detailed information soon.
In This Issue
► September news: Executive summary
► Commercial plans transition to MCG care guidelines
► We're streamlining our 2024 HMO product options
► Secondary code edits implementing in November
► Learn + earn credits: Lifestyle medicine and nutrition
Take our Stigma-Free AZ pledge
Blue Cross, Blue Shield, the Cross and Shield Symbols, MyBlue, BlueCard, Federal Employee Program, and FEP are registered service marks, and BluePathway and BlueJourney are service marks, of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

The MCG care guidelines are the proprietary and copyright-protected information of MCG Health, part of the Hearst Health network. 

InterQual is a registered trademark, and InterQual criteria are the proprietary and copyright-protected information, of Change Healthcare LLC (part of Optum) and/or one of its subsidiaries.

© 2023 Blue Cross Blue Shield of Arizona, Inc. All rights reserved.


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