We use InterQual criteria, not ‘two-midnight rule,’ for inpatient acute care admissions

Blue Cross Blue Shield of Michigan’s Utilization Management department makes determinations on authorization requests for inpatient acute care admissions of members based on InterQual^® criteria, not the “two-midnight rule.” This applies to all lines of business.

We’re clarifying this because we recently received questions from providers about the two-midnight rule. Providers should do the following:

• Refer to the InterQual criteria for the type of admission and to the associated Blue Cross and Blue Care Network Local Rules.
  
  Note: These rules are available on the Blue Cross Authorization Requirements & Criteria page and the BCN Authorization Requirements & Criteria page of the ereferrals.bcbsm.com website.

• Disregard any information about the two-midnight rule that we may have published in previous communications since that information is no longer current.

We’re updating the provider manuals to include a statement clarifying that we don’t use the two-midnight rule in making determinations on authorization requests for inpatient acute care admissions.