Clinical Coverage Criteria
To learn more about how these criteria are used by Community Health Plan to make sure you get the best care, see Utilization Management.
Pharmacy
- 17 Alpha-Hydroxyprogesterone Caproate (17-P) (UM.101) - 11/2011
- Bevacizumab (Avastin®) (UM.104) - 03/2011
- Docetaxel (Taxotere®) (UM.102) - 11/2011
- Gemcitabine Hydrochloride (Gemzar®) (UM.103) - 11/2011
- Oxaliplatin (Eloxatin™) (UM.105) - 11/2011
- Repository Corticotropin (H.P. Acthar® Gel) (UM.106) - 11/2011
Utilization Management
- Complementary/Alternative Care (Acupuncture, Biofeedback, Chiropractic, Hypnotherapy, Massage Therapy, Naturopathy) (UM.002) - 12/2011
- Continuous Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (Bi-PAP) (UM.003) - 12/2011
- Dialysis (Kidney) (UM.005) - 12/2011
- Durable Medical Equipment (DME) (UM.006) - 12/2011
- Enteral Therapy (UM.007) - 12/2011
- Extended Specialty Services (UM.008) - 12/2011
- Home Health Services (UM.009) - 12/2011
- Occupational Therapy (UM.011) - 12/2011
- Physical Therapy (UM.012) - 12/2011
- Preventive Services and Immunizations (UM.013) - 12/2011
- Reconstructive Plastic Surgery (UM.014) - 12/2011
- Rehabilitation - Inpatient, SNF, CORF (UM.010) - 12/2011
- Speech Therapy (UM.015) - 12/2011
- Transplants: Bone Marrow, Stem Cell & Solid Organs (UM.016) - 12/2011
- Transplant Work-ups/Donor Search/Donation (UM.017) - 12/2011
- Ventilators - Chronic Use (UM.018) - 12/2011
- Hysteroscopic Tubal Sterilization Procedures (UM.019) - 12/2011
- Specialty Referral Visit Limits (UM.020) - 3/2011