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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.