ADDITIONAL APPROVED EVIDENCE BASED CRITERIA RESOURCES

ProCare Advantage Additional Approved Evidence Based

Prior Auth Criteria Resources

Where no National or Local Coverage Determination or applicable Medicare statues and regulations exists, ProCare Advantage will utilize criteria guidelines developed by other approved vendors such as MCG as well as Managed Care Organizations (MCO) for evidence-based medical literature for determinations. These MCO’s guidelines are used for a variety of different products and services.

Please refer to the below list for specific information on how you can access the guidelines.