Accessing MCG Care Guidelines for CHRISTUS Health Plan Members
CHRISTUS Health Plan utilizes MCG care guidelines to assess the medical necessity of health care requests. These guidelines are the protected intellectual property of MCG.
For your convenience, MCG has provided a tool that allows CHRISTUS Health Plan members, and prospective members, to review the MCG care guidelines online. These guidelines aren't printable.
Before Accessing the Guidelines
Before accessing the guidelines, you will need:
- Your determination letter
- Your MCG code - This code is found in your determination letter.
Steps to Accessing the Guidelines
There are four steps to access the guidelines.
- Step 1 - Read and accept the Terms and Conditions by checking the "Accept Terms and Conditions" box.
- Click the Accept and Proceed button.
- Click the Accept and Proceed button.
- Step 2 - Enter your First and Last Name into the boxes. Also, select the category that best fits your interest in the guidelines.
- Click the Next button.
- Click the Next button.
- Step 3 - You need a Verification Code, also referred to as an Access Code, to view the guidelines.
- Specify how you would like to receive the code. Your choices are text message, email or phone number.
- Click the Next button
- Step 4 - Enter your verification code into the Access Code box.
- Click the next button
- This step will take you to the CHRISTUS Health Plan MCG Guidelines index categories.
MCG Category Descriptions
Ambulatory care is medical services provided to patients who do not need to be admitted to a hospital or stay overnight in a healthcare facility.
This can include:
- Specialty clinics like occupational or physical therapy
- Imaging like X-rays or scans
- Certain types of outpatient treatment
Behavioral health care focuses on someone's emotions, behaviors and thoughts.
This can include:
- Mental health
- Substance abuse
- Eating habits
- Medication management that is related to mental health issues
General recovery care is a service provided after a serious medical event. It is the next step in the recovery process and focuses on healing, regaining abilities and preventing future problems.
This can include:
- Physical therapy
- Occupation therapy
- Speech-Language pathology
- Home health services
- Skilled nursing care
Home health care refers to care that is provided to individuals in their own homes and who do not need to be in a hospital or nursing home.
Inpatient care is when a patient needs to stay overnight or for several nights in a hospital or other medical facility.
Surgical care refers to any medical treatment that involves performing surgery on a patient.
Multiple condition management is care for individuals who have two or more chronic and long lasting health conditions at the same time.
Examples of conditions could be:
- Diabetes
- Heart disease
- Arthritis
- Depression
- Asthma
Recovery facility care refers to inpatient medical services provided by specialized facilities after a person has been discharged from a hospital.
Examples of these facilities could be:
- Inpatient rehab hospitals
- Nursing homes
- Long term hospitals
- Substance abuse and mental health facilities