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Optum follows clinical criteria and guidelines found in state and federal statutes and regulations. When clinical criteria have not been fully established under statutes and regulations, Optum uses sound clinical evidence, including evidence-based clinical guidelines from nationally recognized sources, to make coverage determinations as well as to inform discussions about evidence-based practices and discharge planning. In using its clinical criteria, Optum takes individual circumstances into account when determining coverage of behavioral health services.

You are being provided conditional access to the clinical criteria for your personal use only. The clinical criteria may contain third party proprietary and confidential information that is considered intellectual property. Conditional access is non-transferrable, nonexclusive and non-sublicensable and you agree not to publish, distribute, lease, license, copy, modify, translate, decompile, disclose, create nor attempt to create derivative work of the clinical criteria.  Any unauthorized or misuse of the clinical criteria may result in irreparable injury entitling the injured entity to obtain immediate injunctive relief in addition to any other legal remedies available.