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Medicare Milliman Clinical Guidelines (MCG) Rollout

At WellCare, we value everything you do to deliver quality care to our members – your patients, and ensuring they have a positive healthcare experience.

Please be advised that effective March 4,2019, WellCare is adding the Milliman Clinical Guidelines (MCG) criteria for Medicare Inpatient Physical Health, Outpatient Physical Health, and Outpatient Behavioral Health Services.

MCG Health’s guidelines offer an evidence-based approach to the most cost effective care. Delivered through innovative software, their enterprise-wide solutions ensure appropriate care for your patients.

With recent healthcare law changes, payers must navigate a complex environment of regulations in order to maintain compliance. Using clinical decision support from MCG allows WellCare to craft care plans with the latest medical data assembled, while keeping those regulations in mind.

In addition, MCG solutions allows WellCare and providers to share documentation and automate prior authorizations. This cuts administrative costs, which helps you more efficiently improve the member's journey to better health.

MCG guidelines and software are the industry’s gold standard and used by over 80% of the U.S. payer market. They help you provide our members with better healthcare experiences, saving time and money. MCG tools can help reduce length of stay (in acute and post-acute settings) and 30-day hospital readmissions, which can improve independent quality ratings (HEDIS, CMS Stars).

For questions or information regarding general WellCare policy and procedures, please visit our website at . You can also contact Customer Service at 1-855-538-0454.

Quality care is a team effort. Thank you for playing a starring role!

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Last Updated On: 1/23/2019