Prior Auths for Priority Change to InterQual

April 3, 2025

As a result of this transition, the following authorization types will be based on modifications to 2025 InterQual criteria, for all plan types: 

  • Level of care (LOC): Acute Adult* 
  • LOC: Acute Pediatric* 
  • LOC: Inpatient Rehabilitation 
  • LOC: Subacute/Skilled nursing facility 
  • LOC: Home Care Q&A 
  • LOC: Long-Term Acute Care 
  • CP: Durable Medical Equipment 
  • CP: Procedures 
  • Medicare: Post Acute & Durable Medical Equipment
  • Medicare: Procedures 
  • Behavioral health (BH): Adult and Geriatric Psychiatry
  • BH: Child and Adolescent Psychiatry 
  • BH: Substance Use Disorders 
  • BH: Services 

*Several criteria set revisions based on best practices and available evidence