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.
We also use InterQual criteria for select surgical procedures such as spine, hysterectomies, and hip and knee replacements.
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: Rehabilitation LOC: Subacute/SNF LOC: Home Care Q&A LOC: Outpatient Rehabilitation* CP: Procedures |
BH: Adult and Geriatric Psychiatry BH: Child and Adolescent Psychiatry BH: Procedures Q & A BH: Substance Use Disorders |
* excluding chiropractic
MPC_021821-3E-1