skip to main content
Company Information  |  Language Assistance

BLUE REVIEWSM

for Providers

July 2024

Access MCG Care Guidelines Clinical Criteria via Availity® Essentials

Blue Cross and Blue Shield of Illinois uses some, but not all, clinical criteria from MCG Care Guidelines when reviewing requests to determine medical necessity. Our clinical rationale outlined in provider correspondence and Clinical Payment and Coding Policies will guide you to the specific MCG Care Guidelines, when applicable. 

As a helpful resource, you can access MCG Care Guidelines through Availity Essentials.

How to access MCG Care Guidelines through Availity:

Once in the guidelines, you may open any category link and search for services by name and topic using the “control F” keyboard function. 

printer icon

MCG Care Guidelines are administered and provided by MCG Health, an independent company that has contracted with BCBSIL to provide care and disease management for members with coverage through BCBSIL. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.

This content is for informational and educational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider, nor is the information presented intended to replace or supersede any requirements set forth in your contract with BCBSIL. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment.