InterQual Criteria
InterQual® aligns payers and providers with actionable, evidence-based clinical intelligence to support appropriate care and foster optimal utilization of resources.
When we receive a request for authorization or prior approval, our utilization review clinicians use InterQual® criteria to determine if the services and level of care are clinically indicated. If the criteria are met, the request is approved; if the criteria are not met, the request is reviewed by a physician.
Because our medical policies offer clinical guidelines for health care providers, we recommend that members talk with their physician if they have questions. Members should also refer to their specific benefits in their subscriber certificate for the terms, conditions, limitations, and exclusions of coverage.
Member Access to InterQual® *Registration will be required
INTERQUAL musculoskeletal services management
For additional informational see
InterQual Musculoskeletal Services Management #220
InterQual Musculoskeletal Services Management CPT and HCPCS Codes #221
We encourage providers to use InterQual® criteria to submit prior authorization requests for the procedures listed in InterQual Musculoskeletal Services Management CPT and HCPCS Codes #221. Use of InterQual® is recommended because they provide us with the information, we will need to expedite your request.