Interqual Medical Necessity Criteria

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InterQual Actionable Evidence-Based Criteria …

https://www.mckesson.com/documents/health-plans/interqual-criteria/

InterQual Care Planning Criteria Description InterQual Durable Medical Equipment Criteria Address the most challenging, costly and time consuming equipment requiring authorization. They distinguish between senior and general populations (adult and …

InterQual ® Level of Care Criteria - Change Healthcare

https://www.changehealthcare.com/clinical-decision-support/interqual/level-of-care-criteria

InterQual® Behavioral Health Criteria Discover how to manage the delivery of mental health and substance use care, including initial and concurrent level-of-care …

InterQual LOC criteria | Priority Health

https://www.priorityhealth.com/provider/manual/standards/utilization-management-program/interqual-loc-criteria

InterQual ® criteria are a first-level screening tool to assist in determining if the proposed services are clinically indicated and provided in the appropriate level or …

Medical Necessity Criteria | Beacon Health Options

https://www.beaconhealthoptions.com/providers/beacon/handbook/clinical-criteria/

Medical Necessity Criteria varies according to state and/or contractual requirements and member benefit coverage. To determine the proper Medical Necessity Criteria, use the …

Clinical Guidelines | UHCprovider.com

https://www.uhcprovider.com/en/policies-protocols/clinical-guidelines.html

Clinical Guidelines. UnitedHealthcare uses evidence-based clinical guidelines from nationally recognized sources during review of our quality and health …

What You Need to Know About the Utilization Review …

https://www.psqh.com/analysis/what-you-need-to-know-about-the-utilization-review-process/

Acute inpatient hospitals use Milliman and InterQual criteria to help determine the appropriateness of care. Both sets of criteria are evidence-based screening tools …

InterQual Medical Necessity Criteria Provider Frequently …

https://www.cenpatico.com/content/dam/centene/cenpatico/pdfs/Frequently-Asked-Questions-InterQual-MNC.pdf

InterQual’s Medical Necessity Criteria will be used for inpatient, partial, intensive outpatient, outpatient and residential services. Fundamentally, however, Cenpatico’s …

Medical Necessity Criteria | Beacon Health Options of California

https://www.beaconhealthoptionsca.com/providers/medical-necessity-criteria/

The following are criteria sets Beacon of California may utilize to make Medical Necessity determinations: Centers for Medicare and Medicaid (CMS) Criteria The Medicare …

Department of Veterans Affairs VHA DIRECTIVE …

https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=9065

Ensuring that NUMAC approved standardized evidence-based UM review criteria (InterQual®) are used without modification and that UM reviewers have been trained in …

Medical Necessity Guidelines: Procedures for the …

https://tuftshealthplan.com/documents/providers/guidelines/medical-necessity-guidelines/varicose

Medical Necessity Guidelines are developed for selected therapeutic or diagnostic services found to be safe and proven effective in a limited, defined population …

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