Medical Necessity Criteria

To determine whether an intervention or service requested is the most appropriate treatment available, MyMichigan Health Connection's utilization management department uses InterQual to provide nationally recognized, well researched clinical criteria. When necessary, internal criteria is developed in order to remain current with effective treatment modalities, and also to ensure that enrollees have equitable access to safe and effective care. MyMichigan Health Connection evaluates and updates these criteria with a review of updated medical literature.