MCG Care Guidelines 28th edition

Effective September 1, 2024, Wellpoint will upgrade to the 28th edition of MCG Care Guidelines for the following modules. Below is a high level summary of the updates and is not intended to be all inclusive:

• Behavioral Health Care (BHG):
  • The goal length of stay (GLOS) has been changed in two guidelines in the 28th edition of Behavioral Health Care.
• Inpatient & Surgical Care (ISC):
  • The goal length of stay (GLOS) has been changed in a total of 72 Optimal Recovery Guidelines in the 28th edition of Inpatient & Surgical Care. In medical Optimal Recovery Guidelines, the GLOS has been changed in 37 guidelines and the GLOS has been changed in 35 surgical Optimal Recovery Guidelines, in the 28th edition of Inpatient & Surgical Care.
• General Recovery Care (GRG):
  • The benchmark length of stay (BLOS) has been refined in the 28th edition of General Recovery Care.
• Recovery Facility Care (RFC):
  • A total of one guideline has been removed from the 28th edition of Recovery Facility Care.
• Chronic Care (CCG):
  • A total of 10 guidelines have been removed in the 28th edition of Chronic Care.

If you have any questions, please contact Provider Services at 833-731-2162.