Utilization Management Criteria

Seaside Health Plan adopts MCG (formerly Milliman Care Guidelines) including guidelines for:

  • Ambulatory Care
  • Home Care
  • Recovery Facility Care
  • General Recovery Care l Inpatient & Surgical Care l Chronic Care
  • Patient Information

Seaside Health Plan's recommendation of these guidelines is not an authorization, certification, explanation of benefits, or a contract. Benefits and eligibility are determined in accordance with the requirements set forth by the State of California