Priority Health: Prior Authorization Changes to Musculoskeletal Services

November 10, 2021

In July, Priority Health shared plans to move musculoskeletal (MSK) services to InterQual® criteria. In addition, there are a couple other changes happening Jan. 1, 2022.

What’s changing

As of Jan. 1, 2022, we’ll launch the following updates to our prior authorizations:

 

What you need to know

There are no changes to how you submit your authorizations. The new criteria will be uploaded in our GuidingCare tool and when appropriate you’ll be prompted to answer InterQual questions just like you are today.

The 2022 CMS Inpatient Only list applies to services received by our Medicare members. All other members are not applicable to this change.