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Dec 18, 2023 · Our medical policies are guides to evaluate technologies or services for medical necessity. Criteria are established through the assessment of evidence based, peer-reviewed …
Click here to view the InterQual® criteria. If the individual’s condition does not improve within 48 hours, additional clinical information should be submitted to support an inpatient level of care.
· Added Maintenance Therapy and Nursing Criteria for admission and continued stay of Medicare beneficiary to allow for patients who may not have the potential to improve but need inpatient skilled …
Mar 9, 2026 · These measures show whether a health care provider gives recommended care based on guidelines, standards of care or practice parameters; that is, the treatment known to give the best …
Explore how a large national health plan leveraged InterQual® solutions as the catalyst to transforming their UM and CM programs. Our clinical decision support solution for payers, providers and …
Apr 29, 2026 · The InterQual® criteria are used by the utilization review nurses when conducting inpatient, post-acute and home care utilization review. InterQual® criteria are clinically based on best …
HAP Criteria 2022 (formerly HAP Criteria for Inpatient Admissions). Note: This document was renamed for continuity. No other changes were made to the current version. If the inpatient criteria are not met …
InterQual: Over 45 years of delivering evidence-based content Unparalleled, objective criteria supporting value-based care across the continuum of care InterQual® Criteria – Industry-leading medical …
InterQual criteria, published by Change Healthcare LLC, is used in many of Wellmark’s medical review processes to support the medical necessity of health care services. The InterQual criteria is available …
Oct 1, 2025 · The Plan will review requests for a short inpatient stay of 48 hours or less to determine if it is more appropriate to categorize the encounter as an observation stay rather than at an inpatient …
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