Policies and guidelines

Clinical Guidelines

The CCA Health Clinical Guidelines represent the current standard of care for screening and/or management of specific physical, psychiatric, and behavioral health conditions for which there are special considerations that apply to the complex health and adverse social situations of our members. They adhere to recommendations and guidelines upheld by nationally recognized primary and specialty care health experts and advocacy groups. 

Medical Necessity Guidelines

Our Medical Necessity Guidelines specify the medical necessity and appropriateness of healthcare services for the purpose of determining coverage under the applicable health plan, federal and state regulations and coverage criteria, and Change Healthcare criteria. They adhere to standards adopted by national accreditation organizations such as the National Committee for Quality Assurance (NCQA).