Shared Health's main sources of review criteria when evaluating prior authorization requests include Medicare's rules, regulations, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs) and MCG criteria. MCG's clinical editors analyze and classify peer-reviewed papers and research studies each year to develop the care guidelines in strict accordance with the principles of evidence-based medicine. Learn more about MCG criteria here: Care Guidelines for Evidence-Based Medicine (MCG Health) For cases when coverage criteria are not fully spelled out in these resources, we created internal coverage criteria based on current evidence in widely used treatment guidelines or in publicly available clinical literature. The below policies are reviewed yearly, and if additional medical policies are used for review, they are added to the listing to ensure publicly accessible availability.
