We're transitioning to 2024 InterQual criteria starting July 15
We’re aligning to nationally recognized standards to ensure our members are getting the right care, in the right place, at the right time by updating to 2024 InterQual® on July 15, 2024.
Why are we updating to 2024 InterQual?
InterQual is nationally recognized as an industry standard for evidence-based medicine criteria, ensuring appropriate care. These criteria are regularly updated to reflect the most recent evidence-based and clinical standards
What authorization types are affected?
As a result of this transition, the following authorization types will be based on modifications to 2024 InterQual criteria:
- Level of care (LOC): Acute Adult*
- LOC: Acute Pediatric*
- LOC: Inpatient Rehabilitation
- LOC: Subacute/Skilled nursing facility
- LOC: Home Care Q&A
- LOC: Long-Term Acute Care
- CP: Durable Medical Equipment
- CP: Procedures
- Medicare: Post Acute & Durable Medical Equipment
- Medicare: Procedures
- Behavioral health (BH): Adult and Geriatric Psychiatry
- BH: Child and Adolescent Psychiatry
- BH: Substance Use Disorders
- BH: Services
*Several criteria set revisions based on best practices and available evidence