Our registered nurses case management coordinators use mckessons interqual criteria as their main source of decision support. The conditionspecific format presents evidencebased interventions that are specific to the condition and help to costeffectively improve outcomes. Mckessons interqual criteria, the standard for evidencebased clinical decision support, is now accessible on demand through a new cloudbased implementation. Interqual level of care acute criteria adult 2004 mckesson on.
Presented by industry experts, we offer two complimentary, monthly educational webinars focusing on healthcare topics relevant to your specialty. Mckesson brings interqual criteria to the cloud business wire. Interqual behavioral health criteria change healthcare. In the absence of licensed mckesson interqual criteria, amerigroup subsidiaries may use unicare clinical utilization management um guidelines. Interqual criteria are objective and specific to better help ensure the most appropriate care and more consistent, defensible decisionmaking. Our four criteria suites provide comprehensive coverage for medical and behavioral health across all levels of care as well as ambulatory care planning. Available for purchase by course or series of courses, mckesson academy plus is our library of accredited continuing education. The record 2019 interqualr criteria to be implemented aug. The my interqual library screen lists the books that have been downloaded from mckesson to your device. Get the clinical education and training you need with our nocost online portal, featuring over 270 resources, including relias ce training courses, product education and mckesson webinars. Our blended learning programs include selfpaced, webbased training modules and a choice of virtual instructorled or onsite instructorled training. Blue cross blue shield of massachusetts is an independent licensee of the blue cross and blue shield association. We are closely monitoring the outbreak of covid19 and will publish resources to assist you in providing care to our members, your patients.
Change to clinical utilization management guidelines. Abc continued to work closely with the mental health center of denver mhcd to improve routine access, and this collaboration has resulted in the offer of same day appointments for members. To navigate through the ribbon, use standard browser navigation keys. The american society of addiction medicine will be used for substance use. The interqual content portfolio consists of four content. This week we successfully resolved a technical issue that had delayed the implementation of the 2017 criteria past our originally stated october 1 target date. Implementation of the 2017 interqual criteria as a reminder, health partners plans uses mckessons interqual criteria as a guideline for making medical necessity determinations. Their purpose is to help you provide quality care by reducing inappropriate use of medical resources. Interqual evidencebased criteria portfolio enabling shared, clinical decision support mckessons interqual criteria portfolio helps support better patient outcomes through integrated, streamlined care management processes and evidencebased appropriateness of care decision support. Implementation of the 2017 interqual criteria health. Interqual guidelines to determine medical necessity summary effective april 1, 2017, anthem blue cross and blue shield medicaid anthem will begin utilizing interqual guidelines for medical necessity criteria. Kaiser permanente revised milliman guidelines nicu levels. Manage the delivery of mental health and substance use care, including initial and concurrent level. The military health system selects mckessons interqual for.
Sm registered and service marks of the blue cross and blue shield association. The national comprehensive cancer network nccn, a notforprofit alliance of leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Using nationally recognized criteria is consistent with mental health parity requirements. Interqual level of care criteria help healthcare organizations assess the safest and most clinically appropriate care level for more than 95% of reasons for admission.
Price new from used from ringbound, january 1, 1900 please retry. Interqual criteria or mcg care guidelines are used only for. Criteria points support the reasons or indications. Mckesson interqual level of care criteria 20 ringbound january 1, 1900 by mckesson author. The cloud interqual library screen lists the books available to download from mckesson to your device. Interqual evidencebased criteria portfolio enabling shared. Mckesson interqual is an evidencebased clinical criteria that provides support covering medical and behavioral health across all levels of care as well as care planning and complex care management. Medical policies and clinical utilization management guidelines. Apply to care manager, medical director, registered nurse manager and more. Mckesson interqual criteria will continue to be used when no specific unicare medical policies exist. Discover interqual, an evidencebased clinical decision support solution that helps healthcare organizations make appropriate medical utilization decisions. Interqual learning source mckesson s interqual learning source can help meet your staff development needs with rigorous and effective interqual criteria training options. This communication is to inform you that blue cross and blue shield of minnesota blue cross will begin using the 2017 version of interqual on july 14, 2017.
Interqual guidelines to determine medical necessity. Amerihealth dc uses interqual criteria to guide medical necessity. Telemedicine services for amerihealth pennsylvania members through june 30, 2020 updated 5122020. Interqual connecttm enhancing enable automation of. Change healthcare introduces interqual 2019 business wire. Alliance partner software with integrated criteria, and hard copy books. The full list of medical policies and clinical utilization management um guidelines are publicly available on the medical policy and clinical um guideline subsidiary website.
Guidelines like interqual and milliman now mcg, are often recommended and used as the standards to apply for admission decision making. Interqual criteria are set of measurable, clinical indicators, as well as. Easily search and find preapproved ce courses that will help you maintain your ccm. The military health system has licensed all of the interqual level of care, behavioral health and care planning criteria. The board of directors of mckesson today released its response to a request from the international brotherhood of teamsters, a mckesson stockholder, that the board perform an investigation into senior managements and the boards oversight of mckessons compliance with its legal and regulatory obligations. For guidance in making length of stay decisions, hospitals turned primarily to a book produced by the professional. Unit 4 criteria for medical necessity decisions, continued national criteria and corporate medical policy highmark blue shield uses mckesson health solutions interqual criteria andor corporate medical policy in making its determinations of medical necessity and clinical appropriateness. A new approach to inpatient admission status acp hospitalist. Interqual criteria are set of measurable, clinical indicators, as well as diagnostic and therapeutic services, that reflect a patients need for hospitalization.
Mckesson interqual level of care criteria 20 ringbound january 1, 1900 by mckesson author see all formats and editions hide other formats and editions. Mckesson interqual criteria are nationally recognized medical necessity criteria developed by a clinical research staff, which includes physicians, registered nurses, and other health care professionals. Mckesson health solutions interqual criteria is accessible through the. Criteria points are clinical statements that refer to test results, medications, symptoms, findings, monitoring, medical management, functional status, and prescribed therapies. Interqual provider training massachusetts behavioral health. Mckesson board releases findings and recommendations of. Rather than being based on diagnosis, they consider the level of illness of the patient and the services required. Interqual level care criteria skip to main search results amazon prime. Case managers, find ces today through ccmcs pace course offerings. Interqual level of care criteria the interqual level of care products cover the continuum of care.
Interqual actionable evidencebased criteria portfolio enabling shared, clinical decision support mckessons interqual content portfolio helps support better patient outcomes through integrated, streamlined care management processes and evidencebased appropriateness of care decision support. Forty years ago, interqual debuted as books that users would page through and. Get your interqual licensing credentials from mhs customer hub. Mckesson interqual updates their clinical criteria manual annually. Mckesson interqual level of care criteria 20 mckesson on. If interqual criteria is not available, selecthealth medical necessity policy will be applied. The infection criteria were updated to improve workflow and consistency and new criteria was added for dengue fever, typhoid and ebola. Interqual level of care criteria change healthcare.
Mckesson announces 2010 interqual interrater reliability. Evidencebased criteriaguidelines interqual change healthcare. Blue cross blue shield of michigan and blue care network will start using the 2019 interqual criteria on aug. To the right of the book s you wish to download, tap download. Interqual level of care criteria 2010, longterm acute care, adult. The richness of clinical detail allows for consideration of. Lack of preauthorization if a contracted or noncontracted provider submits a claim for a service that requires preauthorization but has not been preauthorized, the service will be denied and if additional records are submitted, will undergo. It pairs the leading interqual criteria, now available as a web service, with proven and secure connectivity. The developers of the criteria sets included representatives from the disciplines of radiology, internal medicine, nursing, and cardiology and other specialty groups.
Beacon is committed to strengthening and enhancing clinical quality by leveraging this bestinclass, evidencebased criteria. Covid19 coronavirus independence is committed to serving people who rely on us, especially when a significant health risk may be present. Amerihealth began licensing the interqual criteria for acute and subacute rehabilitation services in 2000. The interqual criteria sets are usually updated and released during the second quarter each year. Interqual criteria and the florida medicaid coverage and march 2015 connections newsletter providers amerihealth dc. Interqual interrater reliabilty whats new 2018 in this short video, we discuss irr and introduce recent developments, such as the new assessments, the new interface, and ongoing improvements. Interqual acute adult criteria added a new syncope subset and, in the heart failure subset, the requirement for left v.
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