McLaren Health Plan
Medical Necessity and Clinical Criteria

Medical Necessity and Clinical Criteria

McLaren Health Plan partners with InterQual® to create clinical criteria or standards to determine the medical necessity and appropriateness of health care services.

Clinical criteria help ensure that health care services are evidence based and objective. Clinical criteria are not used to deny care. Clinical criteria can help improve health outcomes and may also help reduce the cost of services.

Refer to InterQual® for the below clinical criteria guidelines: https://prod.ds.interqual.com/service/connect/transparency?tid=dc31b123-941a-4127-a79e-44d2eb3980d5

World Professional Association for Transgender Health (WPATH) criteria may be used in addition to InterQual criteria for gender reassignment/affirmation. WPATH criteria are listed here: https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644