Interqual level of care criteria 2010, longterm acute care, adult. Forty years ago, interqual debuted as books that users would page through and annotate. Interqual mobile offers you aroundtheclock access to the latest and most accurate clinical content at your fingertips. Interqual level of care criteria change healthcare. Ensure that services are provided in a timely and efficient manner. Mckesson gives classes and certificate examinations and ceus for certifications that they invent all the time.
Designed for android and ios apple mobile devices, interqual mobile is an enhanced digital version of the interqual books. The interqual adult 2006 acute and rehabilitationsubacute criteria were applied by clinical staff trained in its use and in the associated software. Numerous and frequentlyupdated resource results are available from this search. Utilization management and care coordination section 7 georgia provider handbook medicaid september 2011 section 7 page 7 of 24 authorization will occur concurrently based on interqual criteria for appropriateness of continued stay to. Mckesson launches new interqual ondemand training solution. Interqual clinical guidelines training for criteria and technology customers. These include interqual, milliman, and other proprietary systems. Our registered nurses case management coordinators use mckessons interqual criteria as their main source of decision support. Blue cross blue shield of massachusetts is an independent licensee of the blue cross and blue shield association. The american society of addiction medicine will be used for substance use. The full list of medical policies and clinical utilization management um guidelines are publicly available on the medical policy and clinical um guideline subsidiary website. We are closely monitoring the outbreak of covid19 and will publish resources to assist you in providing care to our members, your patients. Interqual level of care criteria are available for. Interqual guidelines to determine medical necessity.
The criteria address the varying needs of geriatric, adult, adolescent, and child patients with both psychiatric and substance use disorders. To access your interqual content for use with interqual mobile, you will need to enter your interqual criteria licensing credentials. Interqual behavioral health criteria support initial and continued stay levelofcare decisions across the behavioral health continuum of care. Interqual andor milliman training for individuals case. To navigate through the ribbon, use standard browser navigation keys. Easily search and find preapproved ce courses that will help you maintain your ccm. Mckesson 2014 study conducted with caqh index data. Interqual learning source offers customers online accessibility. With an outstanding track record, widespread adoption, and continual enhancement, interqual criteria are the standard for evidencebased clinical decision support.
Covid19 coronavirus independence is committed to serving people who rely on us, especially when a significant health risk may be present. I am pleased to introduce this publication and i am especially pleased with the work of the cmi committee members who have been meeting regularly, despite their busy work schedules and differing time zone challenges in order to deliver such guidelines. Determining level of care appropriateness in the patient. Covid19 coronavirus amerihealth is committed to serving people who rely on us, especially when a significant health risk may be present. Reliable information about the coronavirus covid19 is available from the world health organization current situation, international travel. Case managers, find ces today through ccmcs pace course offerings. Interqual 2014 release raises the bar for evidencebased clinical content at the point of care. Amerihealth began licensing the interqual criteria for acute and subacute rehabilitation services in 2000. Access your interqual criteria on your tablet or smartphone with a few swipes of your finger. Patient financial services weekly advisor, june 21, 2007. Interqual 2014 release raises the bar for evidence.
Online services costsharing mechanisms such as physician office visit copayments and inpatient hospital interqual guidelines and medical policies. Sm registered and service marks of the blue cross and blue shield association. I took one once the cpur exam, though i didnt pay for the course, just for fun, and it was nonsense. The military health system selects mckessons interqual for. Kaiser permanente revised milliman guidelines nicu levels. Expanding and collapsing criteria criteria points may stand alone or be hierarchically embedded in a decision tree. Medical policies and clinical utilization management guidelines. The adolescent age group has been expanded for the imaging, pelvis subset. Utilization management and care coordination overview the.
Community health solutions makes the most of every healthcare dollar december 03, 2014 community health solutions of america chs is a nationally recognized provider of innovative and comprehensive medical care management services for a diverse client base serving more than 200,000 covered lives. If interqual does not cover a behavioral health service. A new approach to inpatient admission status part 1 of 2. Jun 21, 2007 are hospitals bound by interqual criteria when determining patient status.
Discover interqual, an evidencebased clinical decision support solution that helps healthcare organizations make appropriate medical utilization decisions. Two commonly used um criteria frameworks are the mckesson interqual criteria and mcg. Are hospitals bound by interqual criteria when determining. Interqual imaging criteria have added many new indications to existing subsets based on current medical literature. Kaiser permanente revised milliman guidelines nicu levels neonatal intensive care unit level iv if the following conditionsprocedures exist, in addition to the fulfillment of level iii criteria, the approved inpatient days should be assigned at level iv. Interqual level care criteria mckesson interqual level of care criteria 20. General questions why did dhcs decide to go tar free for certain inpatient hospital days in public. Prior to implementing new versions of the interqual criteria, hsi will send a provider update bulletin to all hospital medicaid liaisons advising them of the implementation date of the new criteria. I have a question about what to do when a physician writes orders to admit a patient to the hospital as an inpatient, but the patient did not meet interqual criteria for inpatient status.
Please note that the these are suggestions based on interqual criteria and milliman criteria used by medicare, tenncare tenncare and most of the major payers. This communication is to inform you that blue cross and blue shield of minnesota blue cross will begin using the 2017 version of interqual on july 14, 2017. Forty years ago, interqual debuted as books that users would page through and. Guidelines medical necessity criteria for treatment of behavioral health and it is from this philosophy that our standards and guidelines medical. Interqual debuted as books that users would page through and. Oct 22, 2015 milliman guidelines medical necessity. Molina healthcare s clinical criteria includes mckesson interqual criteria, hayes directory, medicare national and local coverage determinations, applicable medicaid guidelines, molina healthcare medical coverage guidance documents developed by designated corporate medical affairs staff in conjunction with molina healthcare physicians. A new approach to inpatient admission status acp hospitalist. Charting guidelines attending physicians must write a progress note daily on a patients chart not just cosign a residents note. The interqual mobile app has a simple tapandgo menu that gets you to the criteria you need in a matter of seconds without thumbing through the pages of a book. Mckesson interqual criteria update mckesson interqual updates their clinical criteria manual annually.
Interqual criteria our four criteria suites provide comprehensive coverage for medical and behavioral health across all levels of care as well as ambulatory care planning. Blue cross of idaho obtained a license for the mckesson interqual level of care criteria. Apply to director of case management, care manager, medical director and more. Mckesson health solutions interqual criteria is accessible through the. Get your interqual licensing credentials from mhs customer hub. Their purpose is to help you provide quality care by reducing inappropriate use of medical resources. Physicians, not the hospital or case managers, are responsible for making the correct determination. Mckesson interqual training download on free books and manuals search interqual behavioral health adult psychiatry criteria 2014 jun 02, 2014 mckesson s interqual 2014 raises the bar for evidencebased clinical content at the point of care. Oclcs webjunction has pulled together information and resources to assist library staff as they consider how to handle coronavirus.
Interqual level of care criteria 2010, acute care, adult mckesson health solutions, llc on. Evidencebased criteriaguidelines interqual change healthcare. Interqual behavioral health criteria change healthcare. Pap 279 clinical criteria providers portal blue cross of idaho.
The military health system has licensed all of the interqual level of care, behavioral health and care planning criteria. Interqual guidelines to determine medical necessity summary effective april 1, 2017, anthem blue cross and blue shield medicaid anthem will begin utilizing interqual guidelines for medical necessity criteria. Important updates updated mckesson interqual criteria sheets. Mckesson interqual level of care criteria 20 mckesson on. The interqual criteria are formulated by combining systematic, critical assessment of the medical literature by a highly trained interqual clinical development team with feedback from an interqual clinical panel of hundreds of experts. Inpatient hospital admission and medical garner health law. Mckesson health solutions interqual criteria is accessible through the cloud. We compared these products and thousands more to help professionals like you find the perfect solution for your business. The interqual criteria sets are usually updated and released during the second quarter each year.
Department of health care services public hospital project. Jul 31, 2012 screening criteria to analyze medical documentation and make a medical necessity determination on inpatient hospital claims. Different facilities uses different criteria most commonly interqual or milliman. Interqual level of care criteria 2010, acute care, adult. Interqual durable medical equipment criteria have been updated to reflect current medical literature, and 5 new pieces of equipment have been added.
Mckesson is the oldest and largest healthcare company in the nation, serving more than 50% of u. Interqual criteria or mcg care guidelines are used only for. Today the learning source web site includes an array of training. Community health solutions makes the most of every healthcare. We deliver onethird of all medications used daily in north america with operations in more than 16 countries. You collapse the decision tree by clicking the minus sign. Interqual acute adult criteria help determine the appropriateness of admission, continued stay and discharge at acute care. Physicians may request a copy of clinical criteria used to make. Jan 17, 2017 mckesson brings interqual criteria to the cloud.
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