Medical Policies & Clinical UM Guidelines 
Welcome to Empire’s Medical Policies & Clinical Utilization Management (UM) Guidelines website. Our goal in creating this application is to provide you with ready access to electronic versions of medical policies and clinical UM guidelines.  
How to Find Medical Policies & Clinical UM Guidelines 
The tabs on this page are organized as follows: 
Medical Policies  
-Recent Updates 
-By Category 
-By Alpha 
Clinical UM Guidelines 
-Recent Updates 
-By Category 
-By Alpha 
You can locate a medical policy or clinical UM guideline by clicking on the By Category or By Alpha options under each tab. The By Category page lists each category as a link at the top of the page. To view a specific category, click the category link to be redirected. The By Alpha page lists all medical policies or clinical UM guidelines alphabetically by title. There is an alpha index at the top of the page. To find a title, click the appropriate letter to be redirected.  
You can also use the “search” feature, which is now housed in the top navigation, or by clicking the link below. 
Search for Medical Policies & Clinical UM Guidelines
Consumer Tools 
Consumer Tools are a new group of documents that offer information on certain health services and procedures for which a review may occur based on Medically Necessary, Not Medically Necessary, Investigational, Cosmetic and Reconstructive criteria. Consumer Tools provide background information related to benefit decisions and also describe possible positive considerations and risks that will have to be weighed, to support care that is safe and appropriate. The documents also include questions that a doctor may wish to review with her/his patients, our members. We hope that these documents can help enhance the discussion between doctors and their patients (our members), to support informed health care choices related to some of our medical policies and clinical UM guidelines. To help find out if a health service and/or treatment will be covered, and to learn more about the member’s plan benefits, see the certificate of coverage or call the customer service number on the member ID card. 
Functional Endoscopic Sinus Surgery (FESS)
Weight Loss Surgery
Customizations to MCG Care Guidelines  
This document provides a summary of customizations to the MCG Care Guidelines 21st Edition (effective May 1, 2017).  
Contact Us  
The process to contact us has been updated to help ensure the privacy and security of our members’ personal information.  
MEMBERS: Please call the toll-free Customer Service telephone number located on the back of your member ID card.  If you have created an online health insurance account, log in to submit your question through the online Message Center.  
PROVIDERS: Please call the toll-free Customer Service telephone number on the back of the member's ID card. Or, you may log on to the provider portal or contact your Network Relations Representative. 
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