Care Guidelines and Review Criteria

 The VMC Care Management Committee of the Board has approved the use of Milliman USA care guidelines for inpatient concurrent utilization review and for procedures requiring pre-certification.  Hayes is used for evaluation of new technology and Apollo Managed Care Guidelines are used as a supplemental reference.

The criteria used to make individual utilization management decisions is available to providers and members upon request. 

 RN On-Call 24/7

VMC offers nurse reviewer availability 24 hours a day, 7 days a week.   
Please dial 802-363-0974 to reach the on-call nurse during
non-business hours (before 8:00am or after 4:30pm) or on
weekends or holidays.