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January 2017

Reminder: We’ll accept either 2016 InterQual Criteria or 2016.3 Clinical Revisions

In a Dec. 2 web-DENIS message, we reminded you that InterQual® made some revisions to its 2016 criteria in September 2016. The 2016.3 Clinical Revisions relate to the Stroke/TIA section of Acute Adult Criteria and the Pancreatitis, DKA and Infection sections of Acute Pediatric Criteria.

We want to be sure you know that Blue Cross Blue Shield of Michigan will accept either the 2016.3 revisions or the 2016 InterQual Criteria that was distributed in book form to providers last summer.

InterQual also issued 2016.2 Clinical Revisions for skilled nursing facilities, but the changes don’t affect our participating providers because the changes are subject to Blue Cross Blue Shield of Michigan Modifications of InterQual criteria (local rules).

We expect that 2017 InterQual Criteria will be released in the spring.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2016 American Medical Association. All rights reserved.
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