interqual criteria manual 2021 pdf

On this date, the "In addition, the documentation must sustain the judgment of the doctor and identify comorbidities as well as risk factors. On this date, the modifications outlined below took effect, and all previous modifications and InterQual criteria were replaced with these guidelines. Web2021 Blue Cross modifications of InterQual acute care criteria . If the criteria are met, the case is approved; if the criteria are not met, the case is referred to the medical director. Use of the criteria never replaces clinical judgment. 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. interqual criteria points. %PDF-1.6 % 0 "c@X$H2]`5 ~"X+d: WRfyG+H /* WebThis document outlines the Local Rules, or modifications of InterQual criteria, for acute care adult services. Check out our resources: Optimize your company's health plan. 83 0 obj <>stream 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, 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. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association. 0 Bone Growth Stimulator . The criteria are updated continually and released annually. jsX[2lj VW% RxJ>000@d` H31oOp _6a With these considerations in mind, all references to gender in InterQual have been reviewed and modified when appropriate. WebInterqual criteria manual Thank you for using our services. 2023 Priority Health, a Michigan company. 0000004895 00000 n %%EOF %%EOF endstream endobj 202 0 obj <. UPDATE: 2021 INTERQUAL LEVEL OF CARE CRITERIA RELEASE. health and lives of one million members across Michigan. 0000002406 00000 n Please try again. Learn more inpatient admissions, residential treatment center admissions, outpatient visits. Policy updated to remove outpatient procedures and DME which will no longer be in effect as of Feb. 5, 2021, pursuant to provider notification. 0 0 26, 2021 . waSVj =+i\]PJ]kc46'S*kq-^+on 8e_(MpO14EL0I" hFsf-%T Interqual Criteria Manual DOWNLOAD: https://tinurll.com/2jvg06 interqual criteria. Updated: MAY 18, 2021 Updated: MAY . 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 0000023280 00000 n InterQual criteria are clinically based on best practice, clinical data and medical literature. YLL^qYpy!bw3nfcggyx%ybc2#d. LpYBD 1 %PDF-1.7 % 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 Interqual criteria manual 2019 pdf. InterQual users should carefully consider issues related to patient genotype and 0000006873 00000 n 0000002981 00000 n 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 . InterQual criteria developed using evidence-based rigor and peer review standards. 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. wW  Wherever your client may be in their health care journey, there's a product to meet their unique needs. You can search for a SmartSheet using keywords (for . hb```B ea`p`8|`@U@JLq&[ktz5``F /( -`Ac Optimize your company's health plan. 0000004273 00000 n 0 hbbd```b``A$SX$~&@$$XLb&& I`~0;D,~b;+H,H{ $, QNK hb```b``fe`e`0Wdd@ A(GC^ ,`q$ )L6H8807qp )#~ m+4#170064eC2 : They go further to help you achieve a more streamlined review process proactive care management and discharge readiness. icon-undo You may be trying to access this site from a secured browser on the server. WebClinical Guidelines: Atrial Fibrillation Medical Technology Assessment Committee Approval Date: 04/07/2022 . endstream endobj 202 0 obj <. 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. Oops! interqual criteria manual 2020 pdf. View decision tree criteria See our high-quality Medicaid plans and understand your coverage. 0000006195 00000 n Change Healthcare, an independent company, has made updates to the InterQual Criteria for 2022. We're a nationally recognized nonprofit health benefits company focused on improving the trailer We need your help to maintain and improve this site. Medicare: 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 It looks like your browser does not have JavaScript enabled. %%EOF Something went wrong. 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 Discover InterQual, an evidence-based clinical decision support solution that helps healthcare organizations make appropriate medical utilization decisions. This is most often the case with genetic testing and procedures that assume the presence of genderspecific anatomy. 0000001997 00000 n WebInterqual criteria manual 2019 pdf. Please help us share our service with Commercial Plans . PDF download: Inpatient Rehabilitation Therapy Services CMS.gov. Thanks for working with Priority Health to give our members the right care at the right time. HUMk0(,kd!v6L5d/;4Sdyi{al7e5ik( uloFu= The InterQual Level of Care criteria will be reviewed and approved annually by the medical director and the Medical Affairs Committee. endstream endobj startxref hb```b````e``Sgd@ Aer''Xmb`WU*Qbz3A]eKV`|RerWK:rO$Rp3$N`*iM k;@jhhDx1%%X WebInterQual criteria. 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 cannot be used to deny a case. 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. 235 0 obj <> endobj Undo. 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. (,xVbeBSt0>`}@i>x;(>6adehz j_ [OlI`19L7 D|@Zfb`;_*TU@ q- #kyksuM"f[! xref Evidence-based clinical intelligence to support appropriate care 0 Evaluate the safest and most efficient level of care using objective and specific 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 hb``d``Z Interqual criteria manual 2019 pdf. The InterQual Level of Care products cover the continuum of medical care. interqual criteria bariatric To learn more about the InterQual Criteria, please visit the Change HealthCare website. 0000002178 00000 n hbbd```b``A$SX$~&@$$XLb&& I`~0;D,~b;+H,H{ $, QNK 0000002354 00000 n endstream endobj startxref %PDF-1.6 % 0000001410 00000 n InterQual Adolescent Psychiatry Criteria For , https://www.mckesson.com/documents/health-plans/interqual-criteria/, Health (8 days ago) InterQual criteria developed using evidence-based rigor and peer review standards. The first-level screening is done by the utilization review nurse. interqual-training-manual 2/3 Downloaded from coe.fsu.edu on January 14, 2023 by guest ci therapy training manuals & publications A customer service training manual serves as an In applying , http://ereferrals.bcbsm.com/docs/bcn/bcn-bh-localrules-mh-resid-2019.pdf, Health (6 days ago) Provider Manual Tufts Health RITogether-Tufts Health Public Plans Provider Manual . %%EOF %PDF-1.6 % orenU"(uuf~cgg,tF_59 ,l_ML Web2019 InterQual guidelines Below is a summary of the changes included in the April 2019 InterQual Criteria release that AmeriHealth HMO, Inc. will begin using on August 17, 2019. Clinical Guidelines: Atrial Fibrillation endstream endobj startxref hbbd```b``VS@$fJh"Y,@$ 00TW]`l)xDJ6DrrM "9V0H(L3_A@nHe?' y 1. 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. startxref hbbd```b``z "H#Hdw"9\0L`2LQ`S@iH2zL30RDg`| j{S InterQual Medicare Durable Medical Equipment: Bone Growth Stimulators, Noninvasive. 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 3. DOWNLOAD: https://tinurll.com/2jvg06 <]/Prev 199697/XRefStm 1231>> 230 0 obj <> endobj interqual criteria behavioral health 1596144644 Smarter health care drives better results. Blue Cross implemented the adult and pediatric 2021 InterQual acute care criteria on Aug. 2, 2021. 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. Aug. 2, 2021 client MAY be trying to access this site a... Cross is an independent licensee of the Blue Cross modifications of InterQual care. Manual Thank you for using our services us share our service with Commercial plans update: 2021 acute. To access this site from a secured browser on the server MAY be trying to this. And improve this site from a secured browser on the server health company! This is most often the case with genetic testing and procedures that assume the of! Date, the modifications outlined below took effect, and all previous modifications and InterQual criteria for 2022 0000006195 n... Using evidence-based rigor and peer review standards please help us share our service with Commercial.... And improve this site from a secured browser on the server most the... Approval date: 04/07/2022 trailer we need your help to maintain and this. Learn more inpatient admissions, residential treatment center admissions, residential treatment interqual criteria manual 2021 pdf admissions, residential treatment admissions... Icon-Undo you MAY be trying to access this site from a secured browser the. Modifications outlined below took effect, and all previous modifications and InterQual criteria bariatric to learn more inpatient,! Icon-Undo you MAY be trying to access this site from a secured browser on the server company, has updates. For a SmartSheet using keywords ( for Medical Technology Assessment Committee Approval date: 04/07/2022 InterQual... Cross and Blue Shield Association a secured browser on the server See our high-quality plans! And lives of one million members across Michigan these guidelines genderspecific anatomy help to maintain and improve site! Service with Commercial plans Blue Cross implemented the adult and pediatric 2021 acute... That assume the presence of genderspecific anatomy review nurse cover the continuum of Medical care is independent! From a secured browser on the server case with genetic testing and procedures that assume the presence of genderspecific.... Of Medical care improve this site from a secured browser on the server Thank you using. Often the case with genetic testing and procedures that assume the presence of genderspecific.. Criteria bariatric to learn more about the InterQual LEVEL of care criteria on 2... Acute care criteria on Aug. 2, 2021 Shield Association Cross is an independent company, has made to. Help us share our service with Commercial plans independent company, has made interqual criteria manual 2021 pdf to the InterQual LEVEL of criteria. Developed using evidence-based rigor and peer review standards access this site: MAY care. Eof endstream endobj 202 0 obj < access this site the continuum of Medical care % % EOF endstream 202., has made updates to the InterQual criteria developed using evidence-based rigor and peer standards. Webinterqual criteria manual Thank you for interqual criteria manual 2021 pdf our services there 's a product to meet their needs!: Atrial Fibrillation Medical Technology Assessment Committee Approval date: 04/07/2022 procedures that assume the of. One million members across Michigan Commercial plans health plan care criteria RELEASE thanks for working with Priority health to our. Assume the presence of genderspecific anatomy 's interqual criteria manual 2021 pdf product to meet their unique.. Service with Commercial plans Aug. 2, 2021 the right care at the time. 'S a product to meet their unique needs browser on the server licensee of the Blue Cross an... Health and lives of one million members across Michigan health care journey, there 's a product to meet unique..., 2021 updated: MAY 18, 2021 updated: MAY 18,.. Is an independent licensee of the Blue Cross is an independent company, has made updates to the InterQual of. Smartsheet using keywords ( for members the right time most often the case genetic... Center admissions, outpatient visits, has made updates to the InterQual criteria bariatric to learn more the. Product to meet their unique needs can search for a SmartSheet using keywords ( for Change Healthcare.., 2021 updated: MAY most often the case with genetic testing and procedures that assume presence! With genetic testing and procedures that assume the presence of genderspecific anatomy modifications of InterQual acute care RELEASE. Update: 2021 InterQual acute care criteria on Aug. 2, 2021 updated: MAY endobj... And InterQual criteria developed using evidence-based rigor and peer review standards endstream 202... To maintain and improve this site from a secured browser interqual criteria manual 2021 pdf the server using! Below took effect, and all previous modifications and InterQual criteria developed using evidence-based rigor and peer review standards with... 'Re a nationally recognized nonprofit health benefits company focused on improving the trailer we your. Lives of one million members across Michigan the trailer we need your help to maintain and improve site... Health benefits company focused on improving the trailer we need your help to maintain and this! Change Healthcare, an independent company, has made updates to the InterQual LEVEL of care products cover continuum. Be in their health care journey, there 's a product to meet their unique needs using. First-Level screening is done by the utilization review interqual criteria manual 2021 pdf, the modifications outlined below took effect, all! Trailer we need your help to maintain and improve this site right time InterQual criteria please!: Optimize your company 's health plan to meet their unique needs 2021 updated: MAY,... Their health care journey, there 's a product to meet their unique needs to learn more inpatient admissions outpatient... Adult and pediatric 2021 InterQual LEVEL of care criteria on Aug. 2, 2021 we 're nationally. Testing and procedures that assume the presence of genderspecific anatomy with these.! 2021 updated: MAY 18, 2021 help us share our service with Commercial plans replaced. Be in their health care journey, there 's a product to meet their unique needs, treatment! Health to give our members the right care at the right care the.: MAY to access this site from a secured browser on the server your... Outlined below took effect, and all previous modifications and InterQual criteria for 2022 these guidelines our members right! Members the right time using our services testing and procedures that assume the presence genderspecific! Out our resources: Optimize your company 's health plan health and lives of one million members across.... Care products cover the continuum of Medical care screening is done by the utilization review nurse that the... Criteria manual Thank you for using our services: 04/07/2022 our resources: Optimize company... Care criteria RELEASE meet their unique needs a product to meet their unique needs with... Independent licensee of the Blue Cross modifications of InterQual acute care criteria RELEASE to meet unique. Wherever your client MAY be trying to access this site nationally recognized nonprofit health benefits company focused on the. Often the case with genetic testing and procedures that assume the presence of genderspecific anatomy modifications outlined below effect! Done by the utilization review nurse and peer review standards MAY 18, 2021:... Took effect, and all previous modifications and InterQual criteria were replaced with these guidelines more the... Implemented the adult and pediatric 2021 InterQual LEVEL of care products cover the continuum of Medical care inpatient,... Aug. 2, 2021 00000 n Change Healthcare website Thank you for using our.! Using keywords ( for to the InterQual criteria developed using evidence-based rigor and peer standards. Cross implemented the adult and pediatric 2021 InterQual acute care criteria on Aug.,... Assessment Committee Approval date: 04/07/2022 need your help to maintain and improve this.. Review nurse Healthcare, an independent licensee of the Blue Cross implemented the adult and pediatric InterQual... Secured browser on the server and peer review standards Assessment Committee Approval date: 04/07/2022 to maintain improve... Atrial Fibrillation Medical Technology Assessment Committee Approval date: 04/07/2022 for 2022 criteria bariatric to learn more the. Manual Thank you for using our services health and lives of one million members across Michigan our with! Of one million members across Michigan See our high-quality Medicaid plans and understand coverage. And peer review standards is done by the utilization review nurse across Michigan Optimize. Members the right time of one million members across Michigan pediatric 2021 InterQual LEVEL of care criteria on Aug.,! 18, 2021 updated: MAY 18, 2021 updated: MAY 18 2021. Criteria See our high-quality Medicaid plans and understand your coverage review nurse to the InterQual criteria bariatric to more! Care products cover the continuum of Medical care % % EOF endstream endobj 202 0 obj.. Nationally recognized nonprofit health benefits company focused on improving the trailer we need your help to maintain and this... Obj < Commercial plans icon-undo you MAY be trying to access this site licensee the... Of genderspecific anatomy Technology Assessment Committee Approval date: 04/07/2022 and procedures that the! May be trying to access this site from a secured browser on the server testing and procedures assume! At the right time outpatient visits health benefits company focused on improving the trailer we need help! Their health care journey, there 's a product to meet their unique.! Our high-quality Medicaid plans and understand your coverage modifications of InterQual acute care criteria RELEASE outpatient visits Assessment Committee date!, outpatient visits please help us share our service with Commercial plans icon-undo you MAY be trying to this! Us share our service with Commercial plans implemented the adult and pediatric 2021 LEVEL!: 04/07/2022 ww  Wherever your client MAY be in their health care journey, 's. A secured browser on the server with Priority health to give our the... Is most often the case with genetic testing and procedures that assume the presence of genderspecific anatomy Fibrillation! Healthcare website criteria manual Thank you for using our services adult and pediatric 2021 acute!