Clinical Guidelines

Heritage Provider Network and Affiliated Medical Groups (HPN) use Milliman Care Guidelines (MCG) to review authorization requests for medical necessity. MCG Guidelines are the protected intellectual property of MCG. HPN is not able to distribute them without the permission of MCG. MCG has provided a tool that allows HPN members and prospective members to view relevant MCG guidelines, however you will not be able to print them.

Follow the instructions below for access to MCG Guidelines.

• Step 1: Click here to access the MCG Guidelines, read the disclaimer and accept the terms and conditions.
• Step 2: Complete the User Information form.
• Step 3: Complete the verification process to continue.
• Step 4: Click on the arrow icon.
• Step 5: Click on the guidelines you wish to view.

Health Plan Clinical Policies and Guidelines can be accessed by clicking this link.