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Get your inpatient surgeries approved faster using Auth Manager
August 25, 2021

This article is for all providers requesting inpatient surgery authorization

As of September 1, 2021, Authorization Manager will allow you to request authorizations for certain procedures performed in an inpatient setting, including emergency surgery. The InterQual® SmartSheet information you used to submit to us separately is now integrated into the tool. This is in addition to procedures performed in an outpatient setting as noted in our June 11 article.

What services are included?

This increased functionality does not apply to Medicare Advantage members.
  • Hip surgery
  • Hysterectomy
  • Knee surgery
  • Spine surgery

How does this increased functionality work?

  1. Start an initial review request in Authorization Manager. (Log in and go to eTools>Authorization Manager.)
  2. InterQual will launch if you enter a CPT code for hip, knee, spine, or hysterectomy surgery. (InterQual will not launch if you only enter the diagnosis code.)
  3. The InterQual criteria will display in a checklist format. Make selections based on the patient’s known symptoms, diagnostic testing, and prior treatments. The authorization will be approved automatically* if:
    • Criteria are met
    • Members’ eligibility is active
    • There are no benefit limits
    • There is an active referral on file (when required for managed care members)

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. Please attach clinical notes.


Launch InterQual from Authorization Manager fact sheets

* Federal Employee Program member requests will pend for review. Please complete the InterQual steps in Authorization Manager to speed up the approval process.