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October 2017

Blue Cross to implement 2017 InterQual® criteria Oct. 2

Blue Cross Blue Shield of Michigan will implement InterQual® acute care, rehabilitation, long-term acute care, skilled nursing and home health criteria on Oct. 2, 2017. On this date, newly modified InterQual criteria will take effect and all previously published modifications (local rules) will be replaced with the new criteria.

The Blue Cross modifications of the InterQual criteria (local rules) can be accessed online by following these steps:

  • 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.

Note: The 2017 InterQual criteria are only available electronically. Services requiring prenotification or precertification must be submitted via e-referral. For details on registering for e-referral, see the April Record article.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2016 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.