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CRITERIA RULES INTERQUAL

slideshareImage: slideshareInterQualCriteriaInterQualCriteriaare objective and specific to better help ensure the most appropriate care and more consistent, defensible decision-making. Our four criteriasuites provide comprehensive coverage for medical and behavioral health across all levels of care as well as ambulatory care planning.
Evidence-Based Criteria/Guidelines | Utilization
Was this helpful?People also askWhat is Milliman criteria guidelines?What is Milliman criteria guidelines?Milliman Care Guidelines,or MCG,are clinical guidelines to help providers and health plans make decisions about patient care,according to MCG. These guidelines offer guidance for handling a variety of different medical conditions,including diabetes,heart failure,pneumonia,asthma and chronic obstructive pulmonary disease.What are Milliman Care Guidelines? | ReferenceSee all results for this questionWhat are the Asam levels of care?What are the Asam levels of care?+-What is ASAM Level 2.1. Called Intensive Outpatient Services for adolescents and adults,this level of care typically consists of 9 or more hours of service a week or 6 or more hoursfor adults and adolescents respectively to treat multidimensional instability.What are the ASAM Levels of Care? – ASAM Continuum | ASAM Criteria See all results for this questionHow to learn InterQual?How to learn InterQual?Interqual has the book (which is updated constantly) built into the system. References, resources, ebook, help, and glossary are all located in the Interqual system. The paper book will be outdated by the time you get your hands on it So use your Interqual software to review the book. If you have no idea what I am writing,..Learning Interqual - Nursing ForumSee all results for this question
Evidence-Based Criteria/Guidelines | Utilization
Criteria. InterQual Criteria are objective and specific to better help ensure the most appropriate care and more consistent, defensible decision-making. Our four criteria suites provide comprehensive coverage for medical and behavioral health across all levels of care as well as ambulatory care planning.Interqual Level of Care Criteria · Criteria Powered by InterQual · Customize Interqual Criteria
The Record - 2019 InterQual(R) criteria to be implemented
2019 InterQual ® criteria to be implemented Aug. 1 for non-behavioral health determinations. Blue Cross Blue Shield of Michigan and Blue Care Network will start using the 2019 InterQual criteria on Aug. 1, 2019, for all levels of care.
InterQual LOC criteria | Priority Health
InterQual ® criteria are clinically based on best practice, clinical data and medical literature. The criteria are updated continually and released annually. InterQual ® criteria are a first-level screening tool to assist in determining if the proposed services are clinically indicated and provided in the appropriate level or whether further evaluation is required. The first-level screening is done by the utilization review nurse.[PDF]
InterQual Actionable Evidence-Based Criteria Portfolio
InterQual Care Planning Criteria help to identify when imaging studies, procedures, molecular diagnostics, durable medical equipment, specialty referral consultations and specialty pharmaceuticals are medically appropriate based on the evidence.[PDF]
Blue Cross 2019 InterQual criteria implemented
2019 Blue Cross Blue Shield of Michigan modifications (local rules) of InterQual long-term acute care criteria Blue Cross will implement the 2019 InterQual LTAC criteria on Aug. 1, 2019. On this date, the modification outlined below will take effect, and all previous modifications and InterQual criteria will be replaced with this guideline.[PDF]
INTERQUAL Application and Training
INTERQUAL, the implementation of the INTERQUAL Education Plan as established by the PMI Case Management Education Team under the direction of the Vice President of Case Management, PMI, and ensuring the hospital case managers’ accurate application of INTERQUAL and the review process.
InterQual® Level of Care Criteria | Change Healthcare
InterQual® Level of Care Criteria help healthcare organizations assess the safest and most clinically appropriate care level for more than 95% of reasons for admission. The condition-specific format presents evidence-based interventions that are specific to the condition and [PDF]
Medical Necessity & Charting Guidelines
InterQual Guidelines for InterQual Guidelines for Medical Necessity Utilized for Medicare patient Acute Care inpatient or Observation – – Severity of Illness (SI) – – Intensity of Service (IS) Used for Adult and Pediatric Services Offers Discharge Screens Criteria are [PDF]
Inpatient, Outpatient and Observation: Medicare Rules and
InterQual Criteria InterQual: Objective screening criteria used by case managers to screen pts for admission. • “Finding” = SI: severity of illness. How sick is the pt? • “Treatment” = IS: intensity of service. What is ordered? • Must meet both SI and IS criteria to “meet criteria” for admission.
Clinical Decision Support (InterQual) Solutions
Always innovating. For four decades, the InterQual team has upheld the singular vision of improving patient outcomes by advocating and supporting evidence-based care. Our innovative clinical content, technologies, solutions, and services have helped reduce the administrative burden, enhance payer-provider relations, and improve quality care.
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