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