Clinical Criteria

Clinical criteria are used to guide medical decisions regarding diagnosis, management and treatment in health care.

CommunityCare utilizes coverage criteria based on current evidence in widely used treatment guidelines or clinical literature.
InterQual® Transparency

Supporting websites:
CommunityCare may use the following guidelines to support coverage determinations:
Clinical Reference Guidelines

CommunityCare has a partnership with Evolent to administer utilization management for Radiation and Medical Oncology for our Medicare Advantage and Commercial plans. Evolent’s coverage policies can be accessed below.
Evolent Policies