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Other Guidelines

WellCare uses nationally accepted guidelines for assessing level-of-care criteria:

  • The following are utilized for Mental Health services:
    • InterQual
    • LOCUS (adults)
    • CASI-II (children & adolescents)
    • ECSII (0-5 infant MH)
  • American Society for Addiction Medicine (ASAM) for substance abuse
  • Clinical Coverage Guidelines (CCGs) to supplement level-of-care (LOC) criteria


This list provides whether authorization is needed or not for certain procedures and levels of care.


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Last Updated On: 12/4/2020
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