How do I access InterQual criteria?
Viewing the InterQual criteria To help you understand determinations based on the InterQual clinical criteria, we give you access to a read-only version of the criteria at UHCprovider.com/policies > Clinical Guidelines > InterQual Clinical Criteria.
What is the age parameter for the appropriate application of InterQual acute adult criteria?
InterQual Acute Adult Criteria facilities for patients who are age 18 or older. InterQual Acute Adult Criteria are organized by primary condition in this new ‘condition specific’ model and include relevant complications, comorbidities and guideline standard treatments, all in one view.
What is inter Qual?
® An evidence-based clinical decision support solution for payers, providers, and government agencies who want to help ensure clinically appropriate medical utilization decisions.
Does Medicare use InterQual criteria?
Does Medicare/CMS (Centers for Medicare and Medicaid Services) care about Milliman or InterQual criteria? CMS recommends admission guidelines as one of many factors to consider when making an admission decision, but it does not endorse any particular criteria or assign specific authority to them.
Who owns InterQual criteria?
UnitedHealth Group
While UHC framed its decision as a response to provider requests, it coincides with the recent purchase of Change Healthcare, which maintains the InterQual Criteria, by Optum, the healthcare analytics company owned by UHC’s parent company, UnitedHealth Group.
How much does InterQual cost?
The total cost of an authorization is $35-$100 when faxes, phone calls, clinical time and other aspects are considered1.
What is MCG and InterQual?
MCG focuses more on severity of illness and diagnosis. InterQual focuses more on intensity of service required and provides detailed day-by-day guidelines.
What is the difference between MCG and InterQual?
How are InterQual level of care criteria used in healthcare?
InterQual Level of Care Criteria help healthcare organizations assess the clinical appropriateness of patient services across the continuum of care: prospectively, concurrently or retrospectively. Robust clinical detail allows organizations to consider in real time the severity of
What are the InterQual criteria for medical necessity?
InterQual Procedures Criteria Are evidence-based medical necessity guidelines for nearly 300 high-volume, high-cost procedures. The criteria help make documenting medical necessity easy while helping to improve the quality of
What are the criteria for meeting the InterQual?
Meeting Interqual usually requires two separate sets of criteria: Severity of Illness (SI): documentation of the ED diagnosis or diagnoses (not chief complaint). It is not enough to document the patient has shortness of breath; you must try to describe how sick the patient is.
What are the InterQual criteria for CHF exacerbation?
For instance, for a CHF exacerbation, you should indicate if the patient has a new oxygen requirement or is hypoxic/hypoxemic; any indications of end-organ damage (like AKI), requiring positive pressure, X-ray or lab findings that are deranged, or with concomitant medical comorbidities making them worse.