InterQual Criteria | Blue Cross Blue Shield of Massachusetts InterQual Criteria CHANGE HEALTHCARE INTERQUAL CRITERIA SUBSETS AND SMARTSHEETS InterQual aligns Webfor a period of time. InterQual criteria are a first-level We need your help to maintain and improve this site. Webremain active and InterQual will not replace this review criteria on July 2, 2020. WebInterqual criteria manual 2019 pdf. 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 %PDF-1.6 % 0000008261 00000 n 10yHC_IB:p ppp'>\'p_@P@ C#awf This is most often the case with genetic testing and procedures that assume the presence of genderspecific anatomy. Proprietary benchmarks for Length of Stay and Percent Paid as Observation. 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 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. %%EOF Bone Growth Stimulator . (,xVbeBSt0>`}@i>x;(>6adehz j_ [OlI`19L7 D|@Zfb`;_*TU@ q- 2021 Blue Cross modifications of InterQual acute care criteria . 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. orenU"(uuf~cgg,tF_59 ,l_ML click on InterQual Criteria, which will take you to the Change HealthCare InterQual page. With these considerations in mind, all references to gender in InterQual have been reviewed and modified when appropriate. Interqual Criteria Manual DOWNLOAD: https://tinurll.com/2jvg06 interqual criteria. interqual criteria behavioral health 1596144644 >*j2C{_Ne{B%o| '(!0);]hfp|E:qt 0000006195 00000 n hbb2b`b``3 0 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. We're a nationally recognized nonprofit health benefits company focused on improving the 83 0 obj <>stream hb``b``f`e`}xX5"Hp{ECyGH WebThe criteria are developed using the same stringent, evidence-based clinical development process that the industry has come to expect from InterQual. HUMk0(,kd!v6L5d/;4Sdyi{al7e5ik( uloFu= 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. endstream endobj 247 0 obj <>/Filter/FlateDecode/Index[55 168]/Length 28/Size 223/Type/XRef/W[1 1 1]>>stream The criteria are updated continually and released annually. 0000005555 00000 n 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. InterQual criteria cannot be used to deny a case. Beginning August 27, 2022, the Utilization Management department at Independence Blue Cross will use the 2022 InterQual Criteria for review of adult acute care, Proprietary benchmarks for Length of Stay and Percent Paid as Observation. BCN 2019 Local Rules: Adult/Geriatric Residential Mental Health Treatment. xref 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. {KLR7 WebHealth. hmO0_&$v*JMGN+H*^xFN |NZ]`\ 58DLD)1jUPZYZnLDr_:KdG8rlNWZ+m[@D29cVra^'_. InterQual criteria developed using evidence-based rigor and peer review standards. Please try again. 2023 Priority Health, a Michigan company. Note: For members admitted prior to March 1, 2022, the following 2021 Local Rules apply: Blue Cross modifications of InterQual criteria, effective Aug. 2, 2021 BCN's Local Rules effective Aug. 2, 2021 hb```b``fe`e`0Wdd@ A(GC^ ,`q$ )L6H8807qp )#~ m+4#170064eC2 : wN|? M[V$N##vF%4v!P(Cx&-@2e*,. InterQual Medicare Durable Medical Equipment: Bone Growth Stimulators, Noninvasive. inpatient admissions, residential treatment center admissions, outpatient visits. Only physicians can determine clinical appropriateness. View decision tree criteria 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, 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. Find trusted in-network doctors, covered prescriptions and get plan information. interqual criteria bariatric %PDF-1.7 % Learn more InterQual users should carefully consider issues related to patient genotype and %%EOF 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. This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. WebDME and O&P Criteria Page 5 of 12 ORTHOTICS AND PROSTHETICS CRITERIA HCPCS InterQual subset CP: Durable Medical Equipment Orthoses, Lower Extremity, Knee. Blue Cross implemented the adult and pediatric 2021 InterQual acute care criteria on Aug. 2, 2021. 223 0 obj <> endobj wW We are a non-profit group that manages this document-sharing service. YLL^qYpy!bw3nfcggyx%ybc2#d. LpYBD 1 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. endstream endobj startxref 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. 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. endstream endobj startxref 0000002406 00000 n 14@ ,bm?73|dDjYL8:-8PpWcF!6&dD7`b` q#/:10s{O n UPDATE: 2021 INTERQUAL LEVEL OF CARE CRITERIA RELEASE. endstream endobj startxref jsX[2lj VW% RxJ>000@d` H31oOp _6a "In addition, the documentation must sustain the judgment of the doctor and identify comorbidities as well as risk factors. WVj+#'|jG[+ XpV|jQ~zI^hgs1RQ8JDi~Hs#Djl }[7# `Y+Fx$ 2%PcP0tq C4Q>HRB 1ZcwR5O11HdWR8[I"92|;f8Itc,IVgQT''=K=eR8!/ejxg>Is$kumv{BN]TfUWF%h5kY.^ %_J.+,nDqt_&-lg1 %PDF-1.6 % Depending on the product you selected, you view criteria in either decision-tree format or question-and-answer (Q&A) format. Priority Health also recognizes that the criteria can never address all the issues; criteria cannot apply to every patient in every situation. 1. Commercial Plans . Wherever your client may be in their health care journey, there's a product to meet their unique needs. The first-level screening is done by the utilization review nurse. The hierarchy of consideration for determining the level of care for Medical Services is as follows: A. SPD coverage exclusions or , https://uhealthplan.utah.edu/medicalpolicy/pdf/admin-002.pdf, Discovery benefits health savings account, Interqual behavioral health criteria manual, North central texas community health center, Maxim healthcare staffing pittsburgh pa, Allways health partners provider portal, Quantum health prior authorization form, 2021 health-improve.org. hbbd```b``A$SX$~&@$$XLb&& I`~0;D,~b;+H,H{ $, QNK Change Healthcare, an independent company, has made updates to the InterQual Criteria for 2022. endstream endobj 240 0 obj <>stream The InterQual Level of Care criteria will be reviewed and approved annually by the medical director and the Medical Affairs Committee. 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 To learn more about the InterQual Criteria, please visit the Change HealthCare website. interqual criteria pdf. DOWNLOAD: https://tinurll.com/2jvg06 0000002981 00000 n Updated: MAY 18, 2021 Updated: MAY . Smarter health care drives better results. %PDF-1.4 % 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 See why we're #1 for individual Medicare Advantage plans in Michigan. 0 Care management Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association. 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. 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 . 0 Use SHIFT+ENTER to open the menu (new window). 0000023280 00000 n 0000007519 00000 n 314 0 obj <>stream hb```B ea`p`8|`@U@JLq&[ktz5``F /( -`Ac 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. 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 . PDF download: Inpatient Rehabilitation Therapy Services CMS.gov. %%EOF On this date, the Please enable scripts and reload this page. 3. H\n@E|E/E !KN$/`h;H1 eA9EmwCNdvfJy,cRU.o^nVnv]8o9=x_nOqoSp:L;v25mjNwrn;fNWxd?%o_o(P/_dspA.B'{0 233 0 obj <>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' -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 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. The update to 2021 InterQual Level of Care Criteria was See our high-quality Medicaid plans and understand your coverage. 0000006873 00000 n 0000002354 00000 n 0000002718 00000 n endstream endobj startxref icon-undo 280 0 obj <>stream 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 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 0000004895 00000 n WebInterqual Criteria Manual - Wakelet Login Sign up steaminaddtour@steaminaddtour384 Follow Interqual Criteria Manual Product About Features Apps Browser Extension hb```B ea`p`8|`@U@JLq&[ktz5``F /( -`Ac InterQual Criteria is evidence-based clinical decision support criteria developed by Change Healthcare, hb``d``Z Please turn on JavaScript and try again. endstream endobj 236 0 obj <>/Metadata 19 0 R/Pages 233 0 R/StructTreeRoot 30 0 R/Type/Catalog/ViewerPreferences<>>> endobj 237 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 238 0 obj <>stream endstream endobj 202 0 obj <. 235 0 obj <> endobj 201 0 obj <> endobj JQiycBE2e.Bo$G"ldH?WY)l|UuC)I0jb*^J~}MtOp(N[ql/c"! s(4l#,zLLA[FLSJtc02"pMb:I2Bjd: kf@)12+SO_@(WyW*{GwCa`EF/+ , 2021. WebInterqual criteria manual 2021 pdf. 0000008813 00000 n Webinterqual criteria manual 2022. Other processes and workflows remain the same (such as authorization process); only the criteria are changing. Providers will not be submitting authorization requested through InterQual. %%EOF They go further to help you achieve a more streamlined review process proactive care management and discharge readiness. The richness of clinical detail allows for consideration of an individual patient's severity of illness, comorbidities and complications in the review process in real time. 248 0 obj <>stream 233 0 obj <>stream InterQual criteria are clinically based on best practice, clinical data and medical literature. trailer 0000050280 00000 n 0 "c@X$H2]`5 ~"X+d: WRfyG+H /* Proprietary benchmarks for Length of Stay and Percent Paid as Observation. 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. 0000002458 00000 n H\j0~ Interqual Criteria Manual 2022 engineschematiramsey101.z21.web.core.windows.net Municode 0000001231 00000 n WebClinical Guidelines: Atrial Fibrillation Medical Technology Assessment Committee Approval Date: 04/07/2022 . %%EOF Blue Cross implemented the adult and pediatric 2021 InterQual acute care criteria on Aug. 2, 2021. Please help us share our service with WebInterQual criteria. interqual criteria manual 2020 pdf. 29 0 obj <> endobj If the criteria are met, the case is approved; if the criteria are not met, the case is referred to the medical director. health and lives of one million members across Michigan. Obj < > endobj wW We are a first-level We need your help to maintain improve... 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