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July 2016
Blue Cross to implement 2016 InterQual® criteria Aug. 1
Reminder: Home care criteria
As we told you last year, InterQual Home Health Care Criteria is only available electronically through the InterQual View application.
You can sign up for home care content within the InterQual View application at mhsinfo.mckesson.com/BCBSMIHomecare.* Organizations with multiple locations will need to sign up for access at each location.
After you sign up, you’ll receive login information and a license key to download and unlock the content with step-by-step instructions.
If you have any questions or concerns about accessing home health care criteria, contact Adair Galster, a senior client executive for McKesson, at 773-935-4605 or Adair.Galster@mckesson.com.
Blue Cross Blue Shield of Michigan will implement 2016 InterQual acute care, rehabilitation, skilled nursing, long-term acute care and home health criteria, starting Aug. 1, 2016.
The criteria format for rehabilitation, skilled nursing and long-term acute care hasn’t changed, but there were some changes made to the home health care criteria format last year. For details, see article at right.
This year, there are still 32 adult and 24 pediatric acute care criteria for specific conditions. General medical and surgical categories will remain in their previous format for patients who don’t fall within a condition-specific subset.
The acute care criteria transition plan section lists those conditions associated with a high risk of readmissions. This information can be useful in determining which patients to refer to our Case Management department.
The "Acute Care Quality Indicators" section lists the indicators for improving the quality of hospital care. The National Quality Forum developed these national standard indicators.
InterQual criteria should be applied to all elective or emergency hospital admissions.
Blue Cross modifications to InterQual criteria, also called local rules, were posted on web-DENIS in June. To access them:
- Log in to web-DENIS.
- Click on BCBSM Provider Publications and Resources in the left column.
- Click on Newsletters & Resources.
- Click on Clinical Criteria & Resources.
Submitting InterQual comments
If you have questions, concerns or comments about InterQual® criteria, email McKesson Health Solutions at CESupport@mckesson.com and include the following:
- The name and address of your facility
- A note indicating that this is a question related to InterQual and which criteria set you’re inquiring about
Or you can email your provider consultant if you have questions. Don’t know who that is? Visit the Contact Us section of bcbsm.com/providers to locate the provider consultant for your area. Click on their name to access their email address.
Note: Our InterQual Criteria Helpline is no longer active.
To help us respond to you quickly and accurately, provide the following information when emailing your provider consultant:
- Criteria book you're using
- Page number from that book
- Criteria you have a question about
- Your question, comment or concern
Here’s an example of how to format a question:
Under “Acute Criteria, Adult” on Page ADLT-15 Acute Coronary Syndrome, INTERMEDIATE, Intervention: Do newer oral anticoagulants alone meet this criterion?
Be sure to include your name and your organization’s name.
**Blue Cross Blue Shield of Michigan doesn’t own or control the content of this website.
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