Milliman Care Guidelines®
To promote quality care, patient safety and the most appropriate use of healthcare resources, ODS follows the evidence-based Milliman Care Guidelines® for:
- In-patient and out-patient surgeries
- Initial and ongoing goal length of stay for admissions to:
- Inpatient facilities, including medical and behavioral health admissions
- Skilled nursing facilities
- Acute in-patient rehabilitation
- Long-term acute care facilities
- Outpatient therapies
- Chiropractic, acupuncture and massage
- Durable medical equipment
The Milliman Care Guidelines are developed using the industry’s most rigorous evidence-based methodology. All content is reviewed annually and updated as necessary by doctors and nurses who cite more than 15,000 unique references, including peer review journals in the current seven-product Care Guidelines series. Milliman Care Guidelines epidemiologists then examine databases that cover a significant portion of the United States population to validate that these published research results are achievable in real-life situations.
The adoption of these new guidelines will not affect your process for notifying ODS of admissions or for seeking prior authorization approval. Those phone calls should still be directed to the ODS Medical Intake Unit at 503-243-4496 or toll-free at 800-258-2037. ODS will continue to use the focus list of services requiring prior authorization.
If you have any additional questions about these changes, please call our Medical Customer Service department at 503-265-2964 or toll-free at 888-217-2363. You also can review the Milliman Care Guidelines online at www.careguidelines.com.
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