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Provider News

Implementation of the 2017 InterQual Criteria

As a reminder, Health Partners Plans uses McKesson’s InterQual® criteria* as a guideline for making medical necessity determinations.

This week we successfully resolved a technical issue that had delayed the implementation of the 2017 criteria past our originally stated October 1 target date. As a result, we were able to implement the 2017 criteria on Monday, October 16.

Effective October 16, we have implemented the 2017 InterQual criteria in these modules:

  • Acute Adult Criteria
  • Acute Pediatric Criteria
  • Long Term Acute Care Criteria
  • Acute Rehabilitation
  • Subacute & SNF
  • Home Care Criteria
  • Outpatient Rehabilitation and Chiropractic
  • Durable Medical Equipment
  • Procedures Criteria
  • Guidelines for Surgery and Procedures Performed in the Inpatient Setting

* InterQual is a proprietary product of McKesson.