Medical Policies
- Abdominoplasty, Panniculectomy, Suction Lipectomy, Lipoabdominoplasty Requests (PDF)
- Ambulance Transport Criteria (PDF)
- Authorization for Observation vs. Inpatient Admission Level of Care (PDF)
- Bariatric Surgery (PDF)
- Bladder and Sacral Nerve Stimulation (PDF)
- Bronchial Thermoplasty (PDF)
- Carrier Screening in Pregnancy (PDF)
- Cell-free Fetal DNA Testing (PDF)
- Chiropractic Care (PDF)
- Cochlear Implant (PDF)
- Continuous Glucose Monitoring (PDF)
- Cosmetic Surgery (PDF)
- Determination of Medical Necessity (PDF)
- Elective Abortion (PDF)
- Experimental and Investigational Procedures (PDF)
- Evaluation of New Technology (PDF)
- Fecal Microbiota Transplant (PDF)
- Genetic Testing (PDF)
- Heart Transplant (PDF)
- Hematopoietic Cell Transplant for Aplastic Anemia and Bone Marrow Failure Syndromes (PDF)
- Hematopoietic Cell Transplantation for Primary Immunodeficiency Disorders (PDF)
- Hematopoietic Cell Transplantation for Multiple Myeloma (PDF)
- Hematopoietic Cell Transplantation in Beta Thalassemia Major (PDF)
- Hematopoietic Cell Transplantation in Hodgkins Lymphoma (PDF)
- Hematopoietic Cell Transplantation in Sickle Cell Disease (PDF)
- Home Birth (PDF)
- Home INR Monitor (PDF)
- Hospice Care Guidelines for Cancer and Non Cancer Diagnosis (PDF)
- Hospice Services (PDF)
- Hyperbaric Oxygen Therapy (PDF)
- Infertility (PDF)
- Inhaled Nitric Oxide (PDF)
- Initial Bone Marrow Transplant (PDF)
- Kidney Transplant (PDF)
- Liver Transplant (PDF)
- Lung Transplant and Evaluation (PDF)
- Medical Weight Loss Management (PDF)
- Member Compliance Medical Policy (PDF)
- Meridian Clinical Policy Readmission Review (PDF)
- Monochromatic Infrared Energy Treatment (PDF)
- Neuropsychological Testing (PDF)
- Occupational Therapy (PDF)
- Orthognathic Surgery (PDF)
- Out of Network and Non-Emergent Out of State Services (PDF)
- Palliative Care (Medicaid) (PDF)
- Pancreas Transplant (PDF)
- Phototherapy and Laser Therapy for Skin Conditions (PDF)
- Physical Therapy (PDF)
- Physician Advisory Committee (PDF)
- Readmission Review (Medicaid) (PDF)
- Reduction Mammoplasty, Mastopexy, Gynecomastia Surgery (PDF)
- Relizorb (PDF)
- Removal or Biopsy of Suspicious Skin Lesions (PDF)
- Replacement Cochlear Implant and Speech Processors (PDF)
- Review of Non-Emergent Out of State Services (PDF)
- Sacral Nerve Stimulation for Fecal Incontinence (PDF)
- Sclerotherapy and Endovascular Ablation (PDF)
- Serious Reportable Events Hospital Acquired Conditions Other Provider Preventable Conditions (PDF)
- Sexual Dysfunction and Impotence (PDF)
- Small Intestine, Small Intestine with Liver of Multivisceral Transplant (PDF)
- Specialized Lenses (PDF)
- Speech Therapy (PDF)
- Stereotactic Body Radiation Therapy (SBRT) and Intensity Modulated Radiation Therapy (IMRT) (PDF)
- Sterilization (PDF)
- Substance Abuse Withdrawal and Intoxication Management (PDF)
- Transplant Evaluation (PDF)
- Urgent and Emergent Care (PDF)
- Ventricular Assist Devices (PDF)