From Priority Health:
Our goal is to work with our provider partners to optimize health outcomes while providing evidence-based, value-driven care. This is why we’ll move to nationally recognized criteria for our musculoskeletal authorizations starting Jan. 1, 2022.
Why are we making this change?
InterQual is nationally recognized as an industry standard for evidence-based medicine criteria, ensuring our members are receiving the right care, in the right place, at the right time. These criteria are regularly updated to reflect the most recent evidence and clinical standards.
Plans types affected
This update affects musculoskeletal authorizations for all product lines, including commercial group and individual plans, Medicare, and Medicaid.
We’ll share additional details throughout the rest of the 2021 year.
Our Auth Request tool will use GuidingCare to process your authorization requests for:
- Post-acute facilities
- Behavioral health
- Durable medical equipment (DME)
- Spine surgery
- Joint surgery
- Home health care
- Planned surgeries and procedures