CommunityCare HMO
CommunityCare Life and Health
Costco mail order service
Lumicera specialty pharmacy
First Health & Valenz Provider Search
Contact EAP
CommunityCare Medical Policies
Providers Resources
Provider PortalLogin or Register
Directory Review
Forms
FDR Program Guide
Medicare Compliance Program Guidelines Attestation
D-SNP Provider Training
FAQs
Contact us
Newsletter
Payment policies
Provider feedback
Jimmo vs. Sebelius
Wellness Tools
Cancer Care
Explanation of Payment (EOP) Notifications
Clinical Criteria
Skilled Nursing
Clinical criteria are used to support consistent, evidence-based decisions regarding the diagnosis, management, and treatment of health care conditions.
CommunityCare uses its plan Medical Policies when an applicable policy is available. When a CommunityCare Medical Policy is not available, CommunityCare uses nationally recognized clinical criteria based on current medical evidence, widely accepted clinical practice guidelines, and relevant clinical literature.
Medical Policies
Medical Drug Oncology Prior Authorization Criteria