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Clinical Guidelines

Clinical Coverage Guidelines

The Clinical Coverage Guidelines (CCG) are evidence-based documents detailing the medical necessity of given procedures or technologies. The guidelines set consistent criteria for the coverage of a procedure or technology, leading to greater consistency and efficiency in clinical decision making. This consistency and efficiency results in better provider/company interactions and increases the quality of our members' health.

Clinical Practice Guidelines

Clinical Practice Guidelines (CPG) are best-practice recommendations based on available clinical outcome and scientific evidence. Wellcare Clinical Practice Guidelines reference expert professional and clinical society recommendations, ensuring that the guidelines contain the highest level of evidence-based content. Clinical Practice Guidelines are also used to guide efforts to improvement the quality of care in our membership.

Guidelines listed as In Review are currently in the approval process; the date listed is the most current copy of the guideline. Guidelines listed as Revised have been reviewed and are current as of the date listed.

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Last Updated On: 1/9/2024
On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.

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