November 15, 2021
Update on InterQual Criteria
Health Partners Plans values your participation and is 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 December 15, 2021, we will implement the 2021 InterQual criteria in these modules:
- Acute Adult Criteria
- Acute Pediatric Criteria
- Long Term Acute Care Criteria
- Acute Rehabilitation Criteria
- Subacute & SNF Criteria
- Home Care Criteria
- Durable Medical Equipment 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.