This article is for all providers (excluding dentists) caring for our members
To help us share our claims decision-making criteria with you as soon as we make updates, we have changed the way you access InterQual® criteria on our website. The Level of Care Criteria Application (also called the InterQual Transparency Tool) on the page is now hosted by Change Healthcare.
In addition, we moved the InterQual Criteria & SmartSheet page to the Clinical Resources>Coverage Criteria and Guidelines section on our website.
To access the Transparency Tool, log in and go to Clinical Resources>Coverage Criteria and Guidelines>InterQual Criteria & SmartSheets. Then click Go Now.
Note: You must enable cookies on your browser.
To view, download, or print InterQual criteria:
The criteria included in the Transparency Tool appear in these Change Healthcare products:
|Medical/surgical products||Behavioral health products|
LOC: Acute Adult
LOC: Acute Pediatric
LOC: Long-Term Acute Care
LOC: Home Care Q&A
LOC: Outpatient Rehabilitation*
BH: Adult and Geriatric Psychiatry
BH: Child and Adolescent Psychiatry
BH: Procedures Q & A
BH: Substance Use Disorders
* excluding chiropractic