The 30th edition of MCG’s Care Guidelines will be available on July 27, 2026.
After that date, you will be able to submit authorization requests using the 30th edition for any new requests. Any authorization requests with a start of care date prior to July 27, 2026, will be reviewed using the 29th edition. Continue to use the Predictal application in Availity Essentials to submit authorization requests with clinical information included.
Expedited Clinical Review
Highmark leverages the power of MCG's automation review to streamline our medical necessity and utilization management processes. This enhanced system helps us to more efficiently assess care plans and ensure that our members receive the most appropriate, evidence-based care in a timely manner. Our goal is to reduce administrative burden and provide quicker determinations, ultimately supporting you in delivering exceptional care.
Providers can view a summary of changes for the 30th edition in the April Medical Policy Update newsletter, which is available here.
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