Interqual Guidelines For Medical Necessity

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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 ...

Medical Necessity Criteria - AmeriHealth

https://www.amerihealth.com/providers/policies_guidelines/medical_necessity_criteria.html

The InterQual decision-support tools (criteria) are well recognized and have widespread acceptance within the provider and payer environments. The tools are …

Spotlight on Medical Necessity Criteria for …

https://www.lac.org/assets/files/Spotlight-on-Medical-Necessity-Criteria-for-Substance-Use-Disorder-Treatment.pdf

SPOTLIGHT ON MEDICAL NECESSITY CRITERIA FOR SUBSTANCE USE DISORDER SERVICES | November 6, 2020 | 4 have codified, in state law, the Parity Act standard in …

InterQual ® Level of Care Criteria - Change Healthcare

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

InterQual Acute Care Criteria Specific and objective evidence-based criteria for admission and level of care Directs to observation status for select conditions Integrates …

Evidence-Based Criteria/Guidelines | Utilization …

https://www.changehealthcare.com/clinical-decision-support/interqual

Evidence-based InterQual Criteria to support appropriate care decisions. Make the safest, most efficient care decisions by using objective, specific criteria for both medical and …

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 …

Prior Authorization & Clinical Review Criteria - Health Alliance

https://healthalliance.org/clinical-review-criteria

InterQual® Criteria Access Health Alliance uses medical necessity criteria based on published clinical evidence to make utilization and prior authorization decisions. Use of …

InterQual LOC criteria | Priority Health

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

InterQual ® criteria sets for acute adult, acute pediatric, inpatient rehabilitation and subacute skilled nursing facilities contain objective endpoints for service, allowing …

Medical Necessity Criteria and Clinical Review Guidelines

https://www.medmutual.com/For-Providers/Medical-Necessity-Criteria-and-Clinical-Review-Guidelines

Medical Necessity Criteria and Clinical Review Guidelines Care Management uses nationally recognized and accepted utilization management criteria, as well as internally …

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 …

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