Clinical Criteria Set for Utilization Management Decisions

The Inland Empire Health Plan (IEHP) issued a Request for Proposal (RFP) for a Clinical Criteria Set for Utilization Management Decisions. The contract aims to provide IEHP with a clinical criteria set to support its utilization management processes, including prior, concurrent, and retrospective reviews, as well as clinical initiatives and research. The selected vendor, MCG Health LLC, will provide a nationally recognized clinical criteria set to assist in decision-making for both adult and pediatric populations. Key requirements include criteria for Durable Medical Equipment, Medical Supplies, Inpatient and Outpatient Procedures, Medical Rehabilitation services, and Behavioral Health Services. • The contract is for a Clinical Criteria Set for Utilization Management Decisions • The vendor will provide a nationally recognized clinical criteria set • The contract includes criteria for various medical services and equipment • The IEHP is a local public entity of the State of California • The contract is pending Governing Board approval