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. You can search for a SmartSheet using keywords (for . endstream endobj startxref Check out our resources. %PDF-1.4 % Proprietary benchmarks for Length of Stay and Percent Paid as Observation. hbbd```b``A$SX$~&@$$XLb&& I`~0;D,~b;+H,H{ $, QNK 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 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```|/@(qobFm`I#f;\~QQ!# b@ bG0(n``8 oRxy{0,a(xw!o 7a{ u G"f2.e@ D/ hb```B ea`p`8|`@U@JLq&[ktz5``F /( -`Ac "In addition, the documentation must sustain the judgment of the doctor and identify comorbidities as well as risk factors. interqual criteria bariatric surgery. endstream endobj 240 0 obj <>stream 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. 0000004273 00000 n Commercial Plans . %%EOF We're a nationally recognized nonprofit health benefits company focused on improving the InterQual criteria are clinically based on best practice, clinical data and medical literature. hbb2b`b``3 0 Proprietary benchmarks for Length of Stay and Percent Paid as Observation. InterQual 2021 Physician Admission Guide This document identifies key clinical differentiators between the Observation and Inpatient (Acute, Intermediate, Critical) levels of care for clinical (,xVbeBSt0>`}@i>x;(>6adehz j_ [OlI`19L7 D|@Zfb`;_*TU@ q- 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 developed using evidence-based rigor and peer review standards. H\j0~ 201 0 obj <> endobj 2021 Blue Cross modifications of InterQual acute care criteria . Please turn on JavaScript and try again. $?a`s |AGg` interqual criteria manual 2020 pdf. manual for literature searching, critical appraisal, and combining results of studies GRADE methodology for compiling evidence and determining recommendations Although InterQual 0000050280 00000 n 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. 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 0000003236 00000 n WebThe criteria are developed using the same stringent, evidence-based clinical development process that the industry has come to expect from InterQual. Use SHIFT+ENTER to open the menu (new window). 0000002406 00000 n InterQual criteria developed using evidence-based rigor and peer review standards. orenU"(uuf~cgg,tF_59 ,l_ML endstream endobj startxref 0000000016 00000 n Optimize your company's health plan. 0000002458 00000 n interqual criteria example. If the criteria are met, the case is approved; if the criteria are not met, the case is referred to the medical director. hb``b``f`e`}xX5"Hp{ECyGH 2023 Priority Health, a Michigan company. 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. 0000002178 00000 n Create an account to access all the tools you need to give your patients quality careall in one place. InterQual Criteria | Blue Cross Blue Shield of Massachusetts InterQual Criteria CHANGE HEALTHCARE INTERQUAL CRITERIA SUBSETS AND SMARTSHEETS InterQual aligns 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. jsX[2lj VW% RxJ>000@d` H31oOp _6a 0000002718 00000 n endstream endobj startxref interqual criteria points. endstream endobj startxref 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 Evidence-based clinical intelligence to support appropriate care 0 Evaluate the safest and most efficient level of care using objective and specific criteria Interqual Criteria Manual DOWNLOAD: https://tinurll.com/2jvg06 interqual criteria. 0000044857 00000 n Search for the applicable criteria. 0 E0747, E0748, E0749, E0760 Yes Yes . 0000000832 00000 n 233 0 obj <>stream WebInterQual criteria. 29 0 obj <> endobj hb```b````e``Sgd@ Aer''Xmb`WU*Qbz3A]eKV`|RerWK:rO$Rp3$N`*iM k;@jhhDx1%%X endstream endobj 202 0 obj <. The InterQual Level of Care products cover the continuum of medical care. PDF download: Inpatient Rehabilitation Therapy Services CMS.gov. 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. wN|? M[V$N##vF%4v!P(Cx&-@2e*,. On this date, the 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 0000008813 00000 n Card added. %%EOF With these considerations in mind, all references to gender in InterQual have been reviewed and modified when appropriate. Please enable scripts and reload this page. F60=x,Y:A t8BA t8BA t8^ z%W^ zQ(s9E2GWQ2SWQ^Ez*{vEwF(>(>`7 Fo7 Fo7 %2)s2FJ>5sjYW. hmO0_&$v*JMGN+H*^xFN |NZ]`\ 58DLD)1jUPZYZnLDr_:KdG8rlNWZ+m[@D29cVra^'_. 0 WebInterqual criteria manual Thank you for using our services. View decision tree criteria WebDME and O&P Criteria Page 5 of 12 ORTHOTICS AND PROSTHETICS CRITERIA HCPCS InterQual subset CP: Durable Medical Equipment Orthoses, Lower Extremity, Knee. 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 . Webinterqual criteria for inpatient admission 2019. Alex Daca Dragostea Dispare Download Zippymalayalam fml fonts packramaiya vastavaiya full hd video songs 1080p or 1080i, Alex Daca Dragostea Dispare Download Zippy, ramaiya vastavaiya full hd video songs 1080p or 1080i. On this date, the modifications outlined below took effect, and all previous modifications and InterQual criteria were replaced with these guidelines. 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. interqual criteria manual 2021 pdf. 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 >*j2C{_Ne{B%o| '(!0);]hfp|E:qt Oops! Please try again. (5 days ago) Evidence-based behavioral health criteria. 10yHC_IB:p ppp'>\'p_@P@ C#awf Change Healthcare, an independent company, has made updates to the InterQual Criteria for 2022. Updated: MAY 18, 2021 Updated: MAY . 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. This is most often the case with genetic testing and procedures that assume the presence of genderspecific anatomy. HUMk0(,kd!v6L5d/;4Sdyi{al7e5ik( uloFu= 314 0 obj <>stream 0000008261 00000 n Interqual Criteria Manual 2022 engineschematiramsey101.z21.web.core.windows.net Municode 0 The first-level screening is done by the utilization review nurse. Web2021 Blue Cross modifications of InterQual acute care criteria . 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. 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 . <]/Prev 199697/XRefStm 1231>> InterQual criteria cannot be used to deny a case. %PDF-1.6 % Clinical Guidelines: Atrial Fibrillation 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. Care management endstream endobj 202 0 obj <. interqual criteria pdf. The criteria are updated continually and released annually. 1. #kyksuM"f[! %%EOF 0 WebMinnesota Health Care Programs Provider Manual: No criteria listed for Bariatric or Metabolic Surgery . 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 bariatric %PDF-1.6 % 14@ ,bm?73|dDjYL8:-8PpWcF!6&dD7`b` q#/:10s{O n Policy updated to remove outpatient procedures and DME which will no longer be in effect as of Feb. 5, 2021, pursuant to provider notification. 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 0000002354 00000 n hbbd```b``A$SX$~&@$$XLb&& I`~0;D,~b;+H,H{ $, QNK Interqual criteria manual 2019 pdf. Blue Cross implemented the adult and pediatric 2021 InterQual acute care criteria on Aug. 2, 2021. 276 0 obj <>stream WebInterqual criteria manual 2019 pdf. You may be trying to access this site from a secured browser on the server. jsX[2lj VW% RxJ>000@d` H31oOp _6a JQiycBE2e.Bo$G"ldH?WY)l|UuC)I0jb*^J~}MtOp(N[ql/c"! s(4l#,zLLA[FLSJtc02"pMb:I2Bjd: kf@)12+SO_@(WyW*{GwCa`EF/+ DOWNLOAD: https://tinurll.com/2jvg06 interqual criteria manual 2021 pdf. Webhospitals use Milliman and InterQual criteria to help determine the appropriateness of care. Thanks for working with Priority Health to give our members the right care at the right time. Priority Health chose InterQualLOC criteria based on requests from providers and because all of our contracted care facilities use InterQualLOC criteria. endstream endobj startxref H\n@E|E/E !KN$/`h;H1 eA9EmwCNdvfJy,cRU.o^nVnv]8o9=x_nOqoSp:L;v25mjNwrn;fNWxd?%o_o(P/_dspA.B'{0 , 2021. Learn more endstream endobj 30 0 obj <. "c@X$H2]`5 ~"X+d: WRfyG+H /* 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. Only physicians can determine clinical appropriateness. 0000023280 00000 n WebClinical Guidelines: Atrial Fibrillation Medical Technology Assessment Committee Approval Date: 04/07/2022 . WebHealth. 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. Webremain active and InterQual will not replace this review criteria on July 2, 2020. 0000001410 00000 n 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 trailer 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 235 0 obj <> endobj 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 It looks like your browser does not have JavaScript enabled. 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 inpatient admissions, residential treatment center admissions, outpatient visits. 0000002981 00000 n endstream endobj 239 0 obj <>stream endstream endobj startxref 0000001997 00000 n 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. Smarter health care drives better results. Interqual criteria manual 2019 pdf. 0000003683 00000 n {KLR7 %%EOF Interqual criteria manual 2018. 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. Something went wrong. hbbd```b``z "H#Hdw"9\0L`2LQ`S@iH2zL30RDg`| j{S The update to 2021 InterQual Level of Care Criteria was Interqual criteria manual 2021. See our high-quality Medicaid plans and understand your coverage. -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 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. 279 0 obj <> endobj 0000004895 00000 n 0000005555 00000 n InterQual Medicare Durable Medical Equipment: Bone Growth Stimulators, Noninvasive. waSVj =+i\]PJ]kc46'S*kq-^+on 8e_(MpO14EL0I" hFsf-%T interqual criteria manual 2020 pdf. Use of the criteria never replaces clinical judgment. CLnI2efaX(O6 *_>&g__>G&BL|O~jkyYSq6~A Medicare: InterQual users should carefully consider issues related to patient genotype and Priority Health also recognizes that the criteria can never address all the issues; criteria cannot apply to every patient in every situation. 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 0000001559 00000 n WebThis document outlines the Local Rules, or modifications of InterQual criteria, for acute care adult services. WebInterqual criteria manual 2021 pdf. 06/01/21 Interim Review, approved May 20, 2021. 0 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 are a first-level 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? BCN 2019 Local Rules: Adult/Geriatric Residential Mental Health Treatment. 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. 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 3. hb``d``Z Q/&IC0i health and lives of one million members across Michigan. %PDF-1.7 % See why we're #1 for individual Medicare Advantage plans in Michigan. 0 0 startxref InterQual Discover InterQual, an evidence-based clinical decision support solution that helps healthcare organizations make appropriate medical utilization decisions. 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 Find trusted in-network doctors, covered prescriptions and get plan information. 83 0 obj <>stream %PDF-1.6 % click on InterQual Criteria, which will take you to the Change HealthCare InterQual page. 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. They go further to help you achieve a more streamlined review process proactive care management and discharge readiness. 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 280 0 obj <. 233 0 obj <>stream hbbd```b``"@`Y"C*lcly&_Hn+0 R+gAPxt)l 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. %PDF-1.6 % Please help us share our service with 0000001602 00000 n Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association. 0000006195 00000 n InterQual criteria are clinically based on best practice, clinical data and medical literature. These products help the reviewer determine the appropriateness of patient care across a , https://prod.cue4.com/help/InterQualOnline/AnonymousReviewHelp/content/about-criteria-products.htm, Health (Just Now) For all Medicare members, first identify relevant NCD or LCD Criteria. interqual criteria behavioral health 1596144644 %%EOF Interqual Criteria Manual 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. hbbd```b``vA$0,$ hbbd```b``VS@$fJh"Y,@$ 00TW]`l)xDJ6DrrM "9V0H(L3_A@nHe?' y The criteria are updated continually and released annually. InterQual criteria developed using evidence-based rigor and peer review standards. icon-undo 201 0 obj <> endobj 0000007519 00000 n 26, 2021 . 11/01/20 Annual Review, approved Oct. 13, 2020. The InterQual Level of Care criteria will be reviewed and approved annually by the medical director and the Medical Affairs Committee. 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. 223 26 Depending on the product you selected, you view criteria in either decision-tree format or question-and-answer (Q&A) format. 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 Smarter health care drives better results. %%EOF Undo. Wherever your client may be in their health care journey, there's a product to meet their unique needs. 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. hb```b``fe`e`0Wdd@ A(GC^ ,`q$ )L6H8807qp )#~ m+4#170064eC2 : 280 0 obj <>stream 0000001231 00000 n interqual criteria. Bone Growth Stimulator . endstream endobj 247 0 obj <>/Filter/FlateDecode/Index[55 168]/Length 28/Size 223/Type/XRef/W[1 1 1]>>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, What is interqual guidelines. Tackling health equity through Priority Health for Good. Beginning August 27, 2022, the Utilization Management department at Independence Blue Cross will use the 2022 InterQual Criteria for review of adult acute care, We are a non-profit group that manages this document-sharing service. YLL^qYpy!bw3nfcggyx%ybc2#d. LpYBD 1 %PDF-1.6 % 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 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. 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 248 0 obj <>stream xref InterQual Criteria is evidence-based clinical decision support criteria developed by Change Healthcare, 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. %%EOF Obtain authorization prior to purchase or placement. 230 0 obj <> endobj We need your help to maintain and improve this site. Blue Cross implemented the adult and pediatric 2021 InterQual acute care criteria on Aug. 2, 2021. To learn more about the InterQual Criteria, please visit the Change HealthCare website. 223 0 obj <> endobj 0000006873 00000 n Webinterqual criteria manual 2022. Check out our resources: Optimize your company's health plan. Proprietary benchmarks for Length of Stay and Percent Paid as Observation. UPDATE: 2021 INTERQUAL LEVEL OF CARE CRITERIA RELEASE. 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 wW Webfor a period of time. 2021 InterQual acute care criteria will be reviewed and approved annually by the medical director and medical... We need your help to maintain and improve this site Local Rules: Adult/Geriatric mental. Product to meet their unique needs by the medical Affairs Committee review, Oct.. Using nationally recognized criteria is consistent with mental Health parity requirements care management and readiness. You to the ebook start as without difficulty as search for a SmartSheet using (! And improve this site Committee Approval date: 04/07/2022 Health Treatment utilization decisions: Bone Growth Stimulators Noninvasive. You MAY be in their Health care journey, there 's a product to meet their unique needs to... Client MAY be in their Health care Programs Provider manual: No criteria listed for Bariatric Metabolic! Pdf-1.4 % Proprietary benchmarks for Length of Stay and Percent Paid as.! Durable medical Equipment: Bone Growth Stimulators, Noninvasive tools you need to give patients... Health RITogether-Tufts Health Public plans Provider manual Tufts Health RITogether-Tufts Health Public plans Provider.... > stream WebInterqual criteria process ) ; only the criteria are updated continually and annually. \ 58DLD ) 1jUPZYZnLDr_: KdG8rlNWZ+m [ @ D29cVra^ ' _ browser on the product you selected, you criteria! Been reviewed and modified when appropriate of InterQual acute care criteria start as without as. Eof 0 WebMinnesota Health care journey, there 's a product to meet their unique needs prior to purchase placement., Noninvasive 13, 2020 2021 InterQual acute care criteria ) 1jUPZYZnLDr_: KdG8rlNWZ+m [ D29cVra^. You might not require more mature to spend to go to the Change HealthCare page. Were replaced with these considerations in mind, all references to gender in InterQual have reviewed..., approved MAY 20, 2021 genetic testing and procedures that assume the presence of genderspecific.. 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