Purpose and Function of Utilization Management

The Utilization Management Department works closely with but independent of both the Case Management & Clinical Documentation Departments. In contrast to our affiliates or other facilities where these functions/departments may be combined, it is a split model at McLaren Flint.

Medicare/Medicaid HMO CMS Guidelines

National Coverage Determinations (NCD)

Local Coverage Determinations (LCD)

We also encourage you to click on the Medicare CMS Guidelines link to further assist you in your research.

Third Party Payer Guidelines

*Guidelines vary by affiliate – please consult your respective UM-CM team for information pertaining to site-specific contractual agreements.

Blue Cross Blue Shield (BCBS)

Blue Care Network (BCN)

Health Plus



Total Health Care

United Health Care


Medical Order Sets

CBS Diagnosis List