2018 InterQual criteria implemented

Blue Cross Blue Shield of Michigan implemented InterQual^® acute care, rehabilitation, long-term acute care, skilled nursing and home health criteria, beginning Aug. 6, 2018.

On this date, certain modifications to InterQual criteria took effect and all previous modifications and criteria were replaced with these new guidelines. We alerted health care providers about the implementation date in a web-DENIS message posted Aug. 2, 2018.

We also reported that precertification requests must be submitted via e-referral, effective Aug. 6, 2018. (As reported in an article in the April 2017 Record, we moved from the prenotification system to e-referral, effective July 31, 2017.)

The Blue Cross modifications to InterQual criteria can be accessed from web-DENIS as follows:

From the home page of web-DENIS, click on BCBSM Provider Publications and Resources in the left column.
Click on Newsletters & Resources.
Click on Clinical Criteria & Resources and scroll down to the BCBSM modifications to InterQual criteria section of the page.

Note: 2018 InterQual criteria is also now being used for behavioral health. For details, see the article, We’re using updated utilization management criteria for behavioral health.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.