The ASAM Criteria for Utilization Review and Management

ASAM Criteria book

The ASAM Criteria® is the nation’s most respected, comprehensive, and widely used set of guidelines for matching patients to the right level of care based on the severity of their disease and their multidimensional needs. The common language and universal standards set by The ASAM Criteria establish a framework to help payers and healthcare systems ensure they are offering the full continuum of care to meet patients’ needs.

ASAM provides licensing agreements to payers and managed care entities for the use of The ASAM Criteria in utilization review.

Through the licensing agreement, ASAM provides access to an electronic version of The ASAM Criteria. The electronic version reflects the original layout and pagination of the hardcopy book  and has additional features including “copy and paste” to allow utilization review staff to use portions of the electronic document when issuing medical necessity decisions or recommending treatment or services ,and search using keywords.

The license granted is limited to the number of end-users, annual reviews, and covered lives specified in the licensing agreement.

ASAM has also developed a clinical summary of The ASAM Criteria that managed care companies can license and post on their website to help meet regulatory requirements associated with making medical necessity criteria available to the public. A copy of the summary can also be shared with a third party, including the State, interested in knowing the clinical standards a payer or managed care organization uses while adjudicating claims.

Payers & Managed Care Entities Permissions Request Form