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Prior Authorizations, Tools, and Clinical Coverage Guidelines

last modified 05/09/2012 - 09:31 AM
Contributors: Keri Andersen

resolveuid/2020d5837bb3e7711807ac4aed9f37a2DVHA staff utilizes clinical criteria for making Utilization Review (UR) decisions that are objective and based on sound medical evidence. Approved criteria include the following:

  • McKesson Health Solutions InterQual® Guidelines; 
  • DVHA Clinical Guidelines; 
  • Vermont State Medicaid Rules; 
  • Hayes and Cochrane New Technology Assessments; and   
  • Other Nationally Recognized Evidence Based Criteria. 

McKesson Health Solutions InterQual® Guidelines are available to providers on the Vermont Medicaid secure provider web portal at www.vtmedicaid.com/secure/logon.do . After log-in, look for the link McKesson Smart Sheets on the left window.

 

THERAPY GUIDELINES

PROCEDURE GUIDELINES

 

J CODE GUIDELINES

(Medical Benefit)

INTENSIVE SOCIAL SUPPORT SERVICES
LABORATORY AND RADIOLOGY GUIDELINES

OUT OF STATE

MISCELLANEOUS

      *                                                          DURABLE MEDICAL EQUIPMENT                                            *