CommercialPrior AuthHigh impact
Notification of Change for Medical Guidelines - MCG Replacing Interqual
Medical Mutual of Ohio·In the News
Effective date
Sep 1, 2018
We identified it
Jun 20, 2026
Summary
Medical Mutual is switching from InterQual to MCG Health guidelines for medical necessity determinations, effective September 1, 2018 with full implementation by January 1, 2019. This change affects prior authorization requirements across all service types including inpatient, surgical, ambulatory, home care, and behavioral health.
Action Required
By January 1, 2019: All staff must familiarize themselves with the new MCG guidelines transparency tool accessible through Medmutual.com/provider > Care Management or Provider.medmutual.com > Tools and Resources > Care Management. Update prior authorization workflows to reference MCG instead of InterQual criteria for all inpatient, surgical, ambulatory, home care, and behavioral health services. Review the complete prior authorization list at the provided URL and update internal procedures accordingly.