To view the utilization review criteria that CareCentrix uses in making medical necessity reviews, please click on the applicable link below. Health plans update the criteria regularly. Please check the links below frequently (at least monthly) to ensure you are aware of any updates.

CareCentrix

• Florida Blue Medical Policies


• Horizon Blue Cross Blue Shield of New Jersey


Home Care
Post-Acute Care


• Horizon Blue Cross Blue Shield of New Jersey and Braven Health


Home Care
Post-Acute Care


• Fallon Health Partners Medical Criteria


Diagnosis of Sleep Disordered Breathing in Adults & Children
Treatment of Sleep Disordered Breathing in Adults & Children


• Mass General Brigham Health Plan Medical Criteria


Diagnosis of Sleep Disordered Breathing in Adults & Children
Treatment of Sleep Disordered Breathing in Adults & Children


• Wellcare Clinical Guidelines


• Wellcare Home Health


• Blue Cross Blue Shield of Michigan


• Optima Health


• Optima Health Sleep Management


• Ambetter from Sunshine Health (FL)


• Ambetter from Peach State Health Plan (GA)


• Ambetter from Buckeye Health Plan (OH)


• Ambetter of Illinois (IL)


• Ambetter from MHS


• Ambetter from NH Healthy Families


• Ambetter from PA Health and Wellness


• Ambetter from Magnolia Health


• Ambetter from Absolute Total Care

To provide input to CareCentrix regarding the criteria above, contact CareCentrix directly via email at CCXMedPolicy@CareCentrix.com

CareCentrix does not own the various third party websites referenced above and makes no representation relating to the content or accuracy of the information contained therein. You are solely responsible for your interaction with such third parties, and we encourage you to read the terms of use and privacy policies before accessing any third party websites.