Online peer-to-peer requests, 2022 InterQual criteria coming to GuidingCare

On August 22, we’ll release an upgrade to our provider authorization tool, GuidingCare. This upgrade will feature two key enhancements:

  • Online peer-to-peer review requests
  • 2022 InterQual® criteria updates

Note: The changes outlined below will not impact eviCore authorizations or reviews.

Online peer-to-peer review requests

With the GuidingCare upgrade this August, providers will be able to request peer-to-peer reviews directly in GuidingCare with the click of a button.

  • Participating providers will be required to request peer-to-peer reviews online through GuidingCare rather than calling our phone line, starting August 22.
  • Non-participating providers will still be able to submit their peer-to-peer requests by phone.


This online peer-to-peer request process won’t apply to:

  • Medicare pre-service: peer-to-peer isn't available
  • Behavioral health providers: peer-to-peer process remains the same

2022 InterQual criteria updates

We’re also updating our authorization tool, GuidingCare to 2022 InterQual criteria on Aug. 22, 2022. This update affects inpatient acute, inpatient preservice, post-acute, outpatient and behavioral health authorizations for all product lines, including commercial group and individual plans, Medicare and Medicaid. 

InterQual’s content has been updated to reflect the most recent evidence-based and clinical standards. As a result of this transition, certain types of authorizations will be based on modifications to the following InterQual 2022 criteria:

  •  Level of care (LOC): Acute adult
    Several criteria set revisions based on best practice and available evidence
  • LOC: Acute pediatric
    Several criteria set revisions based on best practice and available evidence
  • LOC: Rehabilitation
  • LOC: Subacute/Skilled nursing facility
  • LOC: Home care Q&A
  • LOC: Long term care acute
  • CP: Durable Medical Equipment
  • CP: Procedures
  • Medicare: Durable Medical Equipment
  • Medicare: Procedures