InterQual® Criteria and Medicare Guidelines

InterQual® Criteria and Medicare Guidelines – Update for 2015

Independent Health utilizes McKesson's InterQual® Criteria to determine the appropriate level of care for our members. InterQual® is nationally recognized evidence-based clinical content and decision support criteria to aid optimal outcomes through integrated, evidence-based clinical care management processes.

InterQual criterion is developed via a rigorous assessment and review process, performed by a panel of over 750 board certified clinical experts from various disciplines. Reference sources for criterion include CMS, SAMHSA, NCQA, and other national evidence based guidelines.

McKesson Health Services has released the 2015 InterQual® clinical criteria updates. The most significant change is the addition of medical and behavioral health comorbidities, thus promoting the most effective evaluation of complex patients.

Independent Health will begin using the 2015 InterQual® criteria for medical necessity coverage determinations for medical and behavioral health requests effective July 1, 2015.

If you would like additional information regarding criteria used to render coverage determinations, please contact our Provider Relations Department at (716) 631-3282.