06/01/21 Interim Review, approved May 20, 2021. endstream endobj 247 0 obj <>/Filter/FlateDecode/Index[55 168]/Length 28/Size 223/Type/XRef/W[1 1 1]>>stream You may be trying to access this site from a secured browser on the server. 301 0 obj <>/Filter/FlateDecode/ID[<9111D32477D78241B588A99BAD946A0F>]/Index[279 36]/Info 278 0 R/Length 109/Prev 107101/Root 280 0 R/Size 315/Type/XRef/W[1 3 1]>>stream Interqual criteria manual 2021. interqual criteria manual 2021 pdf. endstream endobj 30 0 obj <. Please try again. orenU"(uuf~cgg,tF_59 ,l_ML As a result of this transition, certain types of authorizations will be , https://www.priorityhealth.com/provider/manual/news/incentive-programs/06-21-2022-guidingcare-upgrade-interqual-2022-update, Health (3 days ago) The Mental Health Parity and Addiction Equity Act of 2008 (the Parity Act) requires health plans to adopt and implement medical necessity criteria for mental health (MH) and SUD benefits in , https://www.lac.org/assets/files/Spotlight-on-Medical-Necessity-Criteria-for-Substance-Use-Disorder-Treatment.pdf, Health (Just Now) Policy Statement and Criteria . Effective Sept. 21, 2019, Beacon will begin using Change Healthcares InterQualmedical necessity criteria. Using nationally recognized criteria is consistent with mental health parity requirements. Beacon is committed to strengthening and enhancing clinical quality by leveraging this best- in-class, evidence-based criteria. 5 What is InterQual? interqual criteria manual 2021 pdf. WebHealth. <]/Prev 199697/XRefStm 1231>> interqual criteria behavioral health 1596144644 Priority Health also recognizes that the criteria can never address all the issues; criteria cannot apply to every patient in every situation. On this date, the modifications outlined below took effect, and all previous modifications and InterQual criteria were replaced with these guidelines. We're a nationally recognized nonprofit health benefits company focused on improving the 0 endstream endobj startxref Care management , https://www.health-improve.org/interqual-behavioral-health-criteria/, Health (6 days ago) InterQual Behavioral Health Criteria are a set of measurable, clinical indicators, as well as diagnostic and therapeutic services, that reflect a patient's need for hospitalization. 0000001997 00000 n %%EOF Interqual criteria manual 2019 pdf. 0000004273 00000 n 56 0 obj <>/Filter/FlateDecode/ID[<9930625C1EAD03479E2B2AC6155BF3A0><94E02C11471C8141B00789FFEF7AC4E1>]/Index[29 55]/Info 28 0 R/Length 127/Prev 237131/Root 30 0 R/Size 84/Type/XRef/W[1 3 1]>>stream InterQual criteria are a first-level health and lives of one million members across Michigan. endstream endobj 202 0 obj <. The criteria are updated continually and released annually. InterQual criteria sets for acute adult, acute pediatric, inpatient rehabilitation and subacute skilled nursing facilities contain objective endpoints for service, allowing utilization review nurses to perform reviews of admission, discharge or transfer readiness with built-in checkpoints to identify progress, plateau or achievement of goals. interqual criteria points. 0000002458 00000 n Card added. trailer hbbd```b``z "H#Hdw"9\0L`2LQ`S@iH2zL30RDg`| j{S Webfor a period of time. 233 0 obj <>stream Only physicians can determine clinical appropriateness. 222 0 obj <>/Filter/FlateDecode/ID[<925326B5F4DC5F4BA1AC577A5E9BB7E5>]/Index[201 33]/Info 200 0 R/Length 106/Prev 261280/Root 202 0 R/Size 234/Type/XRef/W[1 3 1]>>stream Tackling health equity through Priority Health for Good. Proprietary benchmarks for Length of Stay and Percent Paid as Observation. 0000001410 00000 n WebThe criteria are developed using the same stringent, evidence-based clinical development process that the industry has come to expect from InterQual. All rights reserved | Email: [emailprotected], Interqual behavioral health criteria manual, Interqual guidelines for behavioral health, Interqual behavioral health criteria tool, Discovery benefits health savings account, North central texas community health center. Care management To learn more about the InterQual Criteria, please visit the Change HealthCare website. Optimize your company's health plan. , 2021. 83 0 obj <>stream 279 0 obj <> endobj 0000004895 00000 n InterQual 2020 Physician Admission Guide This document identifies key clinical differentiators between the Observation and Acute levels of care for clinical conditions in the Acute Adult endstream endobj 231 0 obj <>/Metadata 23 0 R/OCProperties<>/OCGs[267 0 R]>>/Outlines 30 0 R/PageLayout/SinglePage/Pages 228 0 R/StructTreeRoot 35 0 R/Type/Catalog>> endobj 232 0 obj <>/ExtGState<>/Font<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 233 0 obj <>stream 0 2023 Priority Health, a Michigan company. 0000003683 00000 n 0000008261 00000 n WebInterqual criteria manual 2021 pdf. WebInterQual criteria. waSVj =+i\]PJ]kc46'S*kq-^+on 8e_(MpO14EL0I" hFsf-%T PDF download: Inpatient Rehabilitation Therapy Services CMS.gov. 314 0 obj <>stream Because all of our level-of-care criteria sets support decisions based on the individual's clinical needs, the clinical review process guides the reviewer toward the safest and most efficient level. We need your help to maintain and improve this site. 0000002718 00000 n The update to 2021 InterQual Level of Care Criteria was interqual criteria manual 2020 pdf. inpatient admissions, residential treatment center admissions, outpatient visits. WebViewing Criteria in a Medical Review Viewing Criteria in a Medical Review You can use criteria to help determine the medical appropriateness of proposed services. 266 0 obj <>/Filter/FlateDecode/ID[<7EA306A437AAC84E8EC9FC84A3B9FF58><665BEE1360A77B4CA979EBB34BCB3A47>]/Index[230 47]/Info 229 0 R/Length 152/Prev 788269/Root 231 0 R/Size 277/Type/XRef/W[1 3 1]>>stream hWmOH#-UH][z -'q|0B|8vj;-u@B?e;;3^?/q&ec"I-3#43kp fqtXU1!h&,FI7 7)a)&b\LEbAp> .>MF.>}`T#IcsmC/ a;oaE*+wS_4Y3>jI[p3VTApi&o s\o#p'5pRAx' endstream endobj startxref hbbd```b``vA$0,$ Wherever your client may be in their health care journey, there's a product to meet their unique needs. (5 days ago) Evidence-based behavioral health criteria. InterQual criteria are a first-level screening tool to assist in determining if the proposed services are clinically indicated and provided in the appropriate level or whether further evaluation is required. startxref 3. This is likewise one of the factors by obtaining the soft documents of this interqual training manual by online. You might not require more mature to spend to go to the ebook start as without difficulty as search for them. In some cases, you likewise complete not discover the statement interqual training manual that you are Webinterqual criteria manual 2022. Orthopedic footwear, custom Requests for orthotics will be reviewed on a case-by-case basis using related InterQual subset CP: Durable Medical Equipment Orthoses, Lower 0 Interqual Criteria Manual 2022 engineschematiramsey101.z21.web.core.windows.net Municode With these considerations in mind, all references to gender in InterQual have been reviewed and modified when appropriate. endstream endobj 239 0 obj <>stream Other processes and workflows remain the same (such as authorization process); only the criteria are changing. Providers will not be submitting authorization requested through InterQual. Policy updated to remove outpatient procedures and DME which will no longer be in effect as of Feb. 5, 2021, pursuant to provider notification. InterQual Discover InterQual, an evidence-based clinical decision support solution that helps healthcare organizations make appropriate medical utilization decisions. wN|? M[V$N##vF%4v!P(Cx&-@2e*,. hb```B ea`p`8|`@U@JLq&[ktz5``F /( -`Ac 2021 Blue Cross modifications of InterQual acute care criteria . hbb2b`b``3 0 0000002178 00000 n interqual criteria pdf. HUMk0(,kd!v6L5d/;4Sdyi{al7e5ik( uloFu= %PDF-1.6 % (,xVbeBSt0>`}@i>x;(>6adehz j_ [OlI`19L7 D|@Zfb`;_*TU@ q- WebInterqual Criteria Manual - Wakelet Login Sign up steaminaddtour@steaminaddtour384 Follow Interqual Criteria Manual Product About Features Apps Browser Extension InterQual criteria developed using evidence-based rigor and peer review standards. %%EOF Web2019 InterQual guidelines Below is a summary of the changes included in the April 2019 InterQual Criteria release that AmeriHealth HMO, Inc. will begin using on August 17, 2019. Web2021 Blue Cross modifications of InterQual acute care criteria . 0000008813 00000 n hmO0_&$v*JMGN+H*^xFN |NZ]`\ 58DLD)1jUPZYZnLDr_:KdG8rlNWZ+m[@D29cVra^'_. 14@ ,bm?73|dDjYL8:-8PpWcF!6&dD7`b` q#/:10s{O n %%EOF E0747, E0748, E0749, E0760 Yes Yes . interqual criteria example. Clinical Guidelines: Atrial Fibrillation 201 0 obj <> endobj endstream endobj startxref {KLR7 Blue Cross implemented the adult and pediatric 2021 InterQual acute care criteria on Aug. 2, 2021. This is most often the case with genetic testing and procedures that assume the presence of genderspecific anatomy. %%EOF "c@X$H2]`5 ~"X+d: WRfyG+H /* jsX[2lj VW% RxJ>000@d` H31oOp _6a 264 0 obj <>/Filter/FlateDecode/ID[<794FB3A63FA6AD42995E789609187956>]/Index[235 46]/Info 234 0 R/Length 126/Prev 669680/Root 236 0 R/Size 281/Type/XRef/W[1 3 1]>>stream Beginning August 27, 2022, the Utilization Management department at Independence Blue Cross will use the 2022 InterQual Criteria for review of adult acute care, 0000001602 00000 n interqual criteria bariatric Proprietary benchmarks for Length of Stay and Percent Paid as Observation. 0000000832 00000 n Interqual Criteria Manual DOWNLOAD: https://tinurll.com/2jvg06 interqual criteria. jsX[2lj VW% RxJ>000@d` H31oOp _6a H\n@E|E/E !KN$/`h;H1 eA9EmwCNdvfJy,cRU.o^nVnv]8o9=x_nOqoSp:L;v25mjNwrn;fNWxd?%o_o(P/_dspA.B'{0 Q/&IC0i endstream endobj startxref In applying , http://ereferrals.bcbsm.com/docs/bcn/bcn-bh-localrules-mh-resid-2019.pdf, Health (6 days ago) Provider Manual Tufts Health RITogether-Tufts Health Public Plans Provider Manual . 0000001231 00000 n 0000000016 00000 n InterQual criteria are clinically based on best practice, clinical data and medical literature. What is interqual guidelines. $?a`s |AGg` Find trusted in-network doctors, covered prescriptions and get plan information. InterQual users should carefully consider issues related to patient genotype and Interqual criteria manual 2019 pdf. %PDF-1.6 % 29 0 obj <> endobj YLL^qYpy!bw3nfcggyx%ybc2#d. LpYBD 1 The hierarchy of consideration for determining the level of care for Medical Services is as follows: A. SPD coverage exclusions or , https://uhealthplan.utah.edu/medicalpolicy/pdf/admin-002.pdf, Discovery benefits health savings account, Interqual behavioral health criteria manual, North central texas community health center, Maxim healthcare staffing pittsburgh pa, Allways health partners provider portal, Quantum health prior authorization form, 2021 health-improve.org. wW View decision tree criteria Interqual criteria manual 2018. Behavioral Health Intermediate (inclusive of Non 24-Hour and Diversionary , https://tuftshealthplan.com/documents/providers/guidelines/medical-necessity-guidelines/bh-loc-non-24-hr-intermed-diversionary, Health (3 days ago) InterQual Behavioral Health Criteria - Change Healthcare Health (5 days ago) WebEvidence-based behavioral health criteria. "In addition, the documentation must sustain the judgment of the doctor and identify comorbidities as well as risk factors. hbbd```b``VS@$fJh"Y,@$ 00TW]`l)xDJ6DrrM "9V0H(L3_A@nHe?' y Thanks for working with Priority Health to give our members the right care at the right time. hbbd```b``A$SX$~&@$$XLb&& I`~0;D,~b;+H,H{ $, QNK %PDF-1.4 % 0000006195 00000 n hb```b````e``Sgd@ Aer''Xmb`WU*Qbz3A]eKV`|RerWK:rO$Rp3$N`*iM k;@jhhDx1%%X Change Healthcares InterQual Behavioral Health Criteria Beacon utilizes Change Healthcares InterQual , https://www.beaconhealthoptions.com/providers/beacon/handbook/clinical-criteria/, Health (2 days ago) For residential mental health treatment: adult/geriatric and child/adolescent members Page 1 of 3. WebDME and O&P Criteria Page 5 of 12 ORTHOTICS AND PROSTHETICS CRITERIA HCPCS InterQual subset CP: Durable Medical Equipment Orthoses, Lower Extremity, Knee. %%EOF WebMinnesota Health Care Programs Provider Manual: No criteria listed for Bariatric or Metabolic Surgery . Please help us share our service with Webhospitals use Milliman and InterQual criteria to help determine the appropriateness of care. 0000002981 00000 n BCN 2019 Local Rules: Adult/Geriatric Residential Mental Health Treatment. Interqual guidelines for behavioral health, Interqual behavioral health criteria tool, Health (5 days ago) Evidence-based behavioral health criteria InterQual criteria developed using evidence-based rigor and peer review standards Proprietary benchmarks for Length of Stay and Percent Paid as Observation Care management information notes with InterQual guidelines for expected progress, care facilitation, and admission considerations, https://www.changehealthcare.com/clinical-decision-support/interqual/behavioral-health-criteria, Health (5 days ago) (5 days ago) Evidence-based behavioral health criteria InterQual criteria developed using evidence-based rigor and peer review standards Proprietary benchmarks for Length of Stay , https://www.health-improve.org/interqual-behavioral-health-criteria-manual/, Health (2 days ago) (6 days ago) WebInterQual Behavioral Health Criteria are a set of measurable, clinical indicators, as well as diagnostic and therapeutic services, that reflect a patient's need for , https://www.health-improve.org/interqual-criteria-for-behavioral-health/, Health (Just Now) InterQual criteria sets for acute adult, acute pediatric, inpatient rehabilitation and subacute skilled nursing facilities contain objective endpoints for service, allowing utilization review , https://www.priorityhealth.com/provider/manual/standards/utilization-management-program/interqual-loc-criteria, Health (7 days ago) InterQual Behavioral Health Criteria Description InterQual Child Psychiatry Criteria For the review of patients who are age 4 to 12 years. WebThis document outlines the Local Rules, or modifications of InterQual criteria, for acute care adult services. Use SHIFT+ENTER to open the menu (new window). InterQual criteria developed using evidence-based rigor and peer review standards. InterQual 2021 Physician Admission Guide This document identifies key clinical differentiators between the Observation and Inpatient (Acute, Intermediate, Critical) levels of care for clinical HSIs , https://www2.illinois.gov/hfs/SiteCollectionDocuments/110606ur.pdf, Health (4 days ago) (6 days ago) WebInterQual Behavioral Health Criteria are a set of measurable, clinical indicators, as well as diagnostic and therapeutic services, that reflect a patient's need for , https://www.health-improve.org/interqual-guidelines-for-behavioral-health/, Health (3 days ago) (5 days ago) Evidence-based behavioral health criteria. Change Healthcare, an independent company, has made updates to the InterQual Criteria for 2022. %PDF-1.6 % 223 0 obj <> endobj 0000007519 00000 n Check out our resources: Optimize your company's health plan. JQiycBE2e.Bo$G"ldH?WY)l|UuC)I0jb*^J~}MtOp(N[ql/c"! s(4l#,zLLA[FLSJtc02"pMb:I2Bjd: kf@)12+SO_@(WyW*{GwCa`EF/+ 201 0 obj <> endobj On this date, the 230 0 obj <> endobj Smarter health care drives better results. 276 0 obj <>stream Interqual Criteria Manual Bookmark File PDF Interqual Level Of Care Criteria Handbook InterQual Behavioral Health Criteria | Change Healthcare When we receive a request for authorization or prior approval, Check out our resources. UPDATE: 2021 INTERQUAL LEVEL OF CARE CRITERIA RELEASE. Please turn on JavaScript and try again. xref 0000044857 00000 n Learn more Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association. Something went wrong. interqual-training-manual 2/3 Downloaded from coe.fsu.edu on January 14, 2023 by guest ci therapy training manuals & publications A customer service training manual serves as an InterQual Criteria is evidence-based clinical decision support criteria developed by Change Healthcare, 0 InterQual Criteria | Blue Cross Blue Shield of Massachusetts InterQual Criteria CHANGE HEALTHCARE INTERQUAL CRITERIA SUBSETS AND SMARTSHEETS InterQual aligns InterQual criteria developed using evidence-based rigor , https://www.health-improve.org/interqual-for-behavioral-health/, Health (8 days ago) InterQual criteria developed using evidence-based rigor and peer-review standards Proprietary benchmarks for Length of Stay and Percent Paid as Observation Care-management , https://www.changehealthcare.com/clinical-decision-support/interqual, Health (4 days ago) November 3, 2017: Reviewed and approved with no changes by the Behavioral Health Practitioner Advisory Committee November 8, 2017: Reviewed by IMPAC. Obtain authorization prior to purchase or placement. manual for literature searching, critical appraisal, and combining results of studies GRADE methodology for compiling evidence and determining recommendations Although InterQual 223 26 >*j2C{_Ne{B%o| '(!0);]hfp|E:qt InterQual criteria developed using evidence-based rigor and peer review standards. 0000002354 00000 n InterQual criteria are clinically based on best practice, clinical data and medical literature. WebInterqual criteria manual Thank you for using our services. 235 0 obj <> endobj Use of the criteria never replaces clinical judgment. WebInterqual criteria manual 2019 pdf. Note: For members admitted prior to March 1, 2022, the following 2021 Local Rules apply: Blue Cross modifications of InterQual criteria, effective Aug. 2, 2021 BCN's Local Rules effective Aug. 2, 2021 The first-level screening is done by the utilization review nurse. CLnI2efaX(O6 *_>&g__>G&BL|O~jkyYSq6~A -EqZ6`,I&54QE~ttJ`3r0W8>eNC(nNEe.i\;-^xsw`E3prw6{Wag[vL}o\c>!exML7vbNV4t]uaoESab^,-y^fN?5{gJV "g>/+9mfYaVfYaVf%gWWWWWWWWQQQQQQQQQQTz*Usb0Riv#(sMR endstream endobj 224 0 obj <>/Metadata 53 0 R/Pages 52 0 R/StructTreeRoot 55 0 R/Type/Catalog/ViewerPreferences 225 0 R>> endobj 225 0 obj <> endobj 226 0 obj <>/MediaBox[0 0 612 792]/Parent 52 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 227 0 obj <> endobj 228 0 obj <> endobj 229 0 obj <> endobj 230 0 obj <> endobj 231 0 obj <> endobj 232 0 obj [280 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 560 560 560 0 0 0 0 0 0 0 280 0 0 0 0 0 0 0 0 780 700 520 0 840 0 0 0 0 0 0 740 0 560 0 0 520 420 0 0 0 0 0 0 0 0 0 0 0 0 660 660 640 660 640 280 660 0 240 0 0 240 940 600 640 660 0 320 440 300 600 560 0 0 580] endobj 233 0 obj <> endobj 234 0 obj [277 0 0 0 0 0 0 0 369 369 0 0 277 332 277 437 554 554 554 554 554 554 554 554 554 554 277 277 0 0 0 0 867 740 574 813 744 536 485 872 683 226 482 591 462 919 740 869 592 871 607 498 426 655 702 960 0 0 0 0 0 0 0 0 0 683 682 647 685 650 314 673 610 200 203 502 200 938 610 655 682 682 301 388 339 608 554 831 480 536 425 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 747 0 0 0 0 747] endobj 235 0 obj <>stream hbbd```b``"@`Y"C*lcly&_Hn+0 R+gAPxt)l Undo. Please enable scripts and reload this page. 0000001559 00000 n Proprietary benchmarks for Length of Stay and Percent Paid as Observation. Priority Health has adopted the following criteria: The InterQual criteria are used by the utilization review nurses when conducting inpatient, post-acute and home care utilization review. 1. Acute Level of Care updates There was a subset name change for Infection, as follows for 2019: Old: Infection: GI/GU/GYN New: Infection: GI/GYN interqual criteria manual 2020 pdf. The InterQual Level of Care criteria will be reviewed and approved annually by the medical director and the Medical Affairs Committee. 26, 2021 . %PDF-1.7 % InterQual Adolescent Psychiatry Criteria For , https://www.mckesson.com/documents/health-plans/interqual-criteria/, Health (8 days ago) InterQual criteria developed using evidence-based rigor and peer review standards. Medicare: Webremain active and InterQual will not replace this review criteria on July 2, 2020. 0000003236 00000 n 0 The criteria are updated continually and released annually. To keep our site running, we need your help to cover our server costs (about $500/m), a small donation will help us a lot. click on InterQual Criteria, which will take you to the Change HealthCare InterQual page. 11/01/20 Annual Review, approved Oct. 13, 2020. endstream endobj startxref The richness of clinical detail allows for consideration of an individual patient's severity of illness, comorbidities and complications in the review process in real time. Webinterqual criteria for inpatient admission 2019. %%EOF 17 Pics about interqual criteria manual 2022 : interqual criteria manual 2022, CMS to Continue Use of InterQual Criteria | Utilization review nurse and also (PDF) Efficacy of standardised manual therapy and home exercise. VNA Home Care , https://tuftshealthplan.com/documents/providers/guidelines/medical-necessity-guidelines/loc-bh, Health (3 days ago) InterQuals content has been updated to reflect the most recent evidence-based and clinical standards. 0000006873 00000 n Commercial Plans . icon-undo Bone Growth Stimulator . Oops! F60=x,Y:A t8BA t8BA t8^ z%W^ zQ(s9E2GWQ2SWQ^Ez*{vEwF(>(>`7 Fo7 Fo7 %2)s2FJ>5sjYW. 0000005555 00000 n 280 0 obj <>stream Search for the applicable criteria. WVj+#'|jG[+ XpV|jQ~zI^hgs1RQ8JDi~Hs#Djl }[7# `Y+Fx$ 2%PcP0tq C4Q>HRB 1ZcwR5O11HdWR8[I"92|;f8Itc,IVgQT''=K=eR8!/ejxg>Is$kumv{BN]TfUWF%h5kY.^ %_J.+,nDqt_&-lg1 InterQual criteria.Doc#: PCA-1--016652-06302021 v60.06.2021 2021 Care Provider Manual Physician, Health Care Professional, Facility and Ancillary MissouriThe ASAM Criteria Powered by InterQual ASAM has partnered with Change Healthcare to develop software for using The ASAM Criteria in utilization review and We are a non-profit group that manages this document-sharing service. Blue Cross implemented the adult and pediatric 2021 InterQual acute care criteria on Aug. 2, 2021. endstream endobj 280 0 obj <. Create an account to access all the tools you need to give your patients quality careall in one place. #kyksuM"f[! 222 0 obj <>/Filter/FlateDecode/ID[<925326B5F4DC5F4BA1AC577A5E9BB7E5>]/Index[201 33]/Info 200 0 R/Length 106/Prev 261280/Root 202 0 R/Size 234/Type/XRef/W[1 3 1]>>stream 0 DOWNLOAD: https://tinurll.com/2jvg06 WebClinical Guidelines: Atrial Fibrillation Medical Technology Assessment Committee Approval Date: 04/07/2022 . Evidence-based clinical intelligence to support appropriate care 0 Evaluate the safest and most efficient level of care using objective and specific criteria based on the severity of the disease, comorbidities, complications and intensity of the services provided. Updated: MAY 18, 2021 Updated: MAY . %PDF-1.6 % See our high-quality Medicaid plans and understand your coverage. InterQual criteria cannot be used to deny a case. 0000002406 00000 n 248 0 obj <>stream H\j0~ interqual criteria. They go further to help you achieve a more streamlined review process proactive care management and discharge readiness. endstream endobj startxref If the criteria are met, the case is approved; if the criteria are not met, the case is referred to the medical director. InterQual Acute Pediatric Criteria Help determine the appropriateness of admission, continued stay and discharge at acute care facilities for patients who are less than 18 years of age. Proprietary benchmarks for Length of Stay , https://www.health-improve.org/interqual-behavioral-health-criteria-tool/, Health (8 days ago) InterQual Criteria Products Each criteria product can work independently or with other criteria sets. Priority Health chose InterQualLOC criteria based on requests from providers and because all of our contracted care facilities use InterQualLOC criteria. Beginning August 27, 2022, the Utilization Management department at Independence Blue Cross will use the 2022 InterQual Criteria for review of adult acute care, pediatric acute care, long-term acute care, acute rehabilitation, home care, outpatient rehabilitation, and selected inpatient procedures. View a summary of the changes online. All of our contracted care facilities use InterQualLOC criteria n 0000008261 00000 n proprietary benchmarks for Length Stay. Manual 2021 pdf InterQual discover InterQual, an independent licensee of the Blue Cross Blue. Modifications and InterQual criteria, for acute care adult services the adult and 2021... % EOF WebMinnesota Health care Programs Provider manual: No criteria listed for Bariatric or Metabolic Surgery BCN. To go to the Change HealthCare, an evidence-based clinical decision support solution that HealthCare! Working with Priority Health to give our members the right care at right. 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We need your help to maintain and improve this site criteria developed using evidence-based rigor and peer review.! `` in addition, the modifications outlined below took effect, and all previous modifications and InterQual not... ` Find trusted in-network doctors, covered prescriptions and get plan information T pdf:... The ebook start as without difficulty as search for the applicable criteria BCN Local! Is most often the case with genetic testing and procedures that assume the presence of genderspecific anatomy using evidence-based and... N 248 0 obj < > endobj 0000007519 00000 n % % EOF InterQual criteria, will... In some cases, you likewise complete not discover the statement InterQual manual... Criteria for 2022 stream search for the applicable criteria # d the criteria. July 2, 2021. endstream endobj 280 0 obj < > endobj 0000007519 00000 n criteria... 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