Clinical Care Guidelines
AlohaCare provides online access to the AlohaCare review guidelines used to determine medical necessity for outpatient prior authorizations, and inpatient hospitalization requests.
Click here to access the MCG website for Guideline Transparency Portal (CGT).
The following is available:
- AlohaCare Medical Policies
- MCG guidelines for Ambulatory Care
- MCG guidelines for Behavioral Health
- MCG guidelines for General Recovery Care
- MCG guidelines for Home Care
- MCG guidelines for Inpatient and Surgical Care
- MCG guidelines for Recovery Facility Care
We will continue to use Medicare Jurisdiction D for Durable Medical Equipment guidelines. Click here to access the Noridian LCD website.
How to Use The Guideline Transparency Portal
Click here to access the Guideline Transparency Quick Start Guide
Medical Policies
AlohaCare's medical policies provide guidance on our coverage benefits. Feel free to contact us if you have any questions about our policies.
Reimbursement Policies
Pharmaceutical Medical Policies
Click here to see the Retired Policies page.