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Authorization requests streamlined for some outpatient surgeries
June 11, 2021

This article is for all providers except dentists

As of June 30, 2021, Authorization Manager will allow requesters to complete the InterQual® medical necessity checklist for certain procedures performed in an outpatient setting.

What services are included?

  • Back surgery
  • Hip surgery
  • Knee surgery
  • Hysterectomy

How does this increased functionality work?

  1. The user initiates initial review request in Authorization Manager.
  2. If a CPT code for back, hip, knee, or hysterectomy surgery is entered, the user will be routed to InterQual.
  3. The InterQual criteria will display in a checklist format. The user will make selections based on the patient’s known symptoms, diagnostic testing, and prior treatments.
  4. If InterQual criteria are met and member’s eligibility is active, the authorization will be approved automatically.

If the criteria aren’t met, or the code entered is not associated with these services, the authorization will pend for manual review and you will be notified.


 Launch InterQual from Authorization Manager fact sheet