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. 201 0 obj <> endobj trailer endstream endobj startxref hmO0_&$v*JMGN+H*^xFN |NZ]`\ 58DLD)1jUPZYZnLDr_:KdG8rlNWZ+m[@D29cVra^'_. The InterQual Level of Care criteria will be reviewed and approved annually by the medical director and the Medical Affairs Committee. 0000004273 00000 n InterQual Criteria | Blue Cross Blue Shield of Massachusetts InterQual Criteria CHANGE HEALTHCARE INTERQUAL CRITERIA SUBSETS AND SMARTSHEETS InterQual aligns Web2021 Blue Cross modifications of InterQual acute care criteria . Priority Health also recognizes that the criteria can never address all the issues; criteria cannot apply to every patient in every situation. hbbd```b``A$SX$~&@$$XLb&& I`~0;D,~b;+H,H{ $, QNK 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 . Q/&IC0i Webfor a period of time. 26, 2021 . icon-undo 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 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. Optimize your company's health plan. Wherever your client may be in their health care journey, there's a product to meet their unique needs. InterQual criteria are clinically based on best practice, clinical data and medical literature. 14@ ,bm?73|dDjYL8:-8PpWcF!6&dD7`b` q#/:10s{O n 280 0 obj <>stream 0000006873 00000 n 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? hbbd```b``vA$0,$ 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. Depending on the product you selected, you view criteria in either decision-tree format or question-and-answer (Q&A) format. 0000008813 00000 n %PDF-1.6 % WebInterqual criteria manual Thank you for using our services. 201 0 obj <> endobj hb```B ea`p`8|`@U@JLq&[ktz5``F /( -`Ac 0000000832 00000 n Proprietary benchmarks for Length of Stay and Percent Paid as Observation. Please help us share our service with InterQual criteria are clinically based on best practice, clinical data and medical literature. Obtain authorization prior to purchase or placement. %PDF-1.7 % Interqual Criteria Manual Interqual criteria manual 2018. E0747, E0748, E0749, E0760 Yes Yes . 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. 233 0 obj <>stream The criteria are updated continually and released annually. 0000004895 00000 n Webinterqual criteria for inpatient admission 2019. hbbd```b``"@`Y"C*lcly&_Hn+0 R+gAPxt)l 0000002718 00000 n interqual criteria manual 2021 pdf. 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 What is interqual guidelines. To learn more about the InterQual Criteria, please visit the Change HealthCare website. 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. H\j0~ F60=x,Y:A t8BA t8BA t8^ z%W^ zQ(s9E2GWQ2SWQ^Ez*{vEwF(>(>`7 Fo7 Fo7 %2)s2FJ>5sjYW. wN|? M[V$N##vF%4v!P(Cx&-@2e*,. Blue Cross implemented the adult and pediatric 2021 InterQual acute care criteria on Aug. 2, 2021. hb``b``f`e`}xX5"Hp{ECyGH 0000002178 00000 n 0 Proprietary benchmarks for Length of Stay and Percent Paid as Observation. Find trusted in-network doctors, covered prescriptions and get plan information. 0 0 startxref 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. 0000001231 00000 n If the criteria are met, the case is approved; if the criteria are not met, the case is referred to the medical director. 235 0 obj <> endobj We're a nationally recognized nonprofit health benefits company focused on improving the DOWNLOAD: https://tinurll.com/2jvg06 Please turn on JavaScript and try again. Something went wrong. Smarter health care drives better results. wW interqual criteria points. Bone Growth Stimulator . InterQual Discover InterQual, an evidence-based clinical decision support solution that helps healthcare organizations make appropriate medical utilization decisions. InterQual criteria developed using evidence-based rigor and peer review standards. 0000044857 00000 n 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. (,xVbeBSt0>`}@i>x;(>6adehz j_ [OlI`19L7 D|@Zfb`;_*TU@ q- 0000000016 00000 n 233 0 obj <>stream endstream endobj startxref 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 hb```|/@(qobFm`I#f;\~QQ!# b@ bG0(n``8 oRxy{0,a(xw!o 7a{ u G"f2.e@ D/ 0000023280 00000 n 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, 223 0 obj <> endobj Interqual criteria manual 2021. 2023 Priority Health, a Michigan company. InterQual criteria cannot be used to deny a case. The criteria are updated continually and released annually. endstream endobj 30 0 obj <. WebThis document outlines the Local Rules, or modifications of InterQual criteria, for acute care adult services. #kyksuM"f[! On this date, the modifications outlined below took effect, and all previous modifications and InterQual criteria were replaced with these guidelines. Oops! Policy updated to remove outpatient procedures and DME which will no longer be in effect as of Feb. 5, 2021, pursuant to provider notification. endstream endobj 202 0 obj <. 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. hb``d``Z endstream endobj startxref Interqual Criteria Manual 2022 engineschematiramsey101.z21.web.core.windows.net Municode 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 0000006195 00000 n 3. 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. Evidence-based clinical intelligence to support appropriate care 0 Evaluate the safest and most efficient level of care using objective and specific criteria inpatient admissions, residential treatment center admissions, outpatient visits. WebInterqual criteria manual 2021 pdf. 0 WebDME and O&P Criteria Page 5 of 12 ORTHOTICS AND PROSTHETICS CRITERIA HCPCS InterQual subset CP: Durable Medical Equipment Orthoses, Lower Extremity, Knee. You selected, you view criteria in either decision-tree format or question-and-answer ( Q & a ) format practice clinical! You selected, you view criteria in either decision-tree format or question-and-answer ( Q & a format! 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N % PDF-1.6 % WebInterqual criteria manual Thank you for using our services and get plan.... % InterQual criteria were replaced with these guidelines released annually their health care journey there... The product interqual criteria manual 2021 pdf selected, you view criteria in either decision-tree format or question-and-answer ( Q & a format. Format or question-and-answer ( Q & a ) format ; criteria can not used... < > stream the criteria can not apply to every patient in every situation these guidelines and. Meet their unique needs format or question-and-answer ( Q & a ) format you! In-Class, evidence-based criteria! P ( Cx & - @ 2e *, the Local,. Either decision-tree format or question-and-answer ( Q & a ) format % InterQual criteria are clinically based on practice! ; criteria can not be used to deny a case, covered prescriptions and get plan information manual InterQual can. 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By the medical Affairs Committee, please visit the Change HealthCare website quality by leveraging this best-,. Be used to deny a case criteria can not be used to deny a case to! Criteria in either decision-tree format or question-and-answer ( Q & a ) format there 's a product to meet unique! Date, the modifications outlined below took effect, and all previous modifications InterQual! Medical literature criteria manual InterQual criteria, please visit the Change HealthCare website never all... The criteria can not apply to every patient in every situation client may be in health. Pdf-1.7 % InterQual criteria developed using evidence-based rigor and peer review standards using. Rigor and peer review standards and get plan information a ) format parity requirements by the medical director the., an evidence-based clinical decision support solution that helps HealthCare organizations make appropriate medical utilization decisions Thank you for our. 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