Our January 2022 updates to prior authorizations are live

In November, we reminded you of important changes coming to prior authorizations in January 2022. The following changes are live starting Jan. 1:

• Musculoskeletal (MSK) services now use 2021 InterQual^® criteria
• Outpatient elective services now use 2021 InterQual criteria
• We are now using the 2022 CMS Inpatient Only list (Medicare only)

What you need to know

There are no changes to how you submit your authorizations. The new criteria is uploaded into GuidingCare and when appropriate you’ll be prompted to answer InterQual questions.

The 2022 CMS Inpatient Only list applies to services received by our Medicare members. All other members are not applicable to this change.