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Medical Mutual Transitioning from MCG to InterQual for Medical Necessity Review Criteria on April 13, 2026
Medical Mutual of Ohio·In the News
Effective date
Apr 13, 2026
We identified it
Jun 20, 2026
Summary
Medical Mutual is switching from MCG to InterQual criteria for medical necessity reviews effective April 13, 2026. The review process remains the same, but the criteria used to evaluate medical necessity will change to align with their Paramount processes.
Action Required
Before April 13, 2026: Clinical and billing teams should familiarize themselves with InterQual medical necessity criteria to ensure documentation and services align with new review standards. Contact Medical Mutual Provider Contracting Manager at 1-800-625-2583 for specific guidance on InterQual requirements.