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InterQual Criteria

Health Partners Plans values your participation and we're always working to provide clear, consistent utilization management guidance.

As a reminder, Health Partners Plans uses McKesson’s InterQual® criteria as a guideline for making medical necessity determinations. Effective October 7, 2019, we implemented the 2019 InterQual criteria in these modules:

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

For more information, contact our Provider Services Helpline at 1-888-991-9023 (M-F, 9:00 a.m. to 5:30 p.m.). As always, thank you for your service to our members.

Resources
May 29: Full letter to providers