Clinical Guidelines
Medical Policies and Clinical UM Guidelines
Martin’s Point Health Care (MPHC) follows CMS and TRICARE guidelines for most coverage and reimbursement determinations. However, there are situations in which MPHC may utilize other guidelines. As a managed care organization, MPHC medical criteria is determine using government program standards along with evidence based clinical resources.
Martin's Point Health Care Medical Necessity Criteria
Clinical UM Guidelines adopted by Martin's Point Health Care
Martin's Point Health Care Part B Step Therapy Clinical Guideline
Martin's Point Health Care Step Therapy Drug List
Medicare Coverage Determination
Medicare Benefit Policy Manual
National Comprehensive Cancer Network (NCCN.org)
Optum Policies (Radiation Oncology and Specialty Pharmacy) - You must be logged in to see this content