Medical Necessity Criteria (MCG Care Guidelines)

CenCal Health uses MCG Guidelines to help review medical necessity for health service requests. MCG Guidelines are the protected intellectual property of MCG. CenCal Health is not able to distribute the MCG Guidelines without the permission of MCG. MCG has provided a tool that allows CenCal Health members, prospective members, contracted providers, and noncontracted providers to view relevant MCG Guidelines; however, you will not be able to print them.

If you would like a printed copy of the criteria you can call CenCal Health Utilization Management at 805-562-1082 or CenCal Health Member Services at 877-814-1861, Monday through Friday, 8 a.m. to 5 p.m. PST, or CA Relay 711, to request a copy of the criteria.

(1) Guideline Number
(2) Guideline Name
Example: A–001 – Cardiac Catheterization and Angiography.

Access Instructions

Please follow the instructions below so that you can access the MCG Guidelines.

Step 1:

Read the MCG disclaimer and accept the Terms and Conditions.

Step 2:

Enter your User Information.

Step 3:

Enter your Contact Information.

Step 4:

Enter your Access Code.

Step 5:

Click on the Guidelines.

If you would like this information in an Alternative Format or another language, please contact CenCal Health Member Services at 877-814-1861, Monday through Friday, 8 a.m. to 5 p.m. PST, or CA Relay 711, to request a copy of the criteria.