We’re transitioning to InterQual® 2020

To continue to better serve you while ensuring our members are getting the right care, in the right place, at the right time, we’re updating to InterQual® 2020 on September 14, 2020 for inpatient and outpatient medical and behavioral health authorizations. 

Why are we updating to 2020 InterQual?

InterQual’s content has been updated to reflect the most recent evidence and clinical standards. 

As a result of this transition, certain types of determinations will be based on modifications to InterQual 2020 criteria, as shown in the table below:

Authorization Modified InterQual criteria for:
Behavioral health
  • Adult and geriatric psychiatry
  • Child and adolescent psychiatry
  • Substance use disorders
  • Procedures - Autism, Transcranial magnetic stimulation (TMS) and Electroconvulsive therapy (ECT)
Inpatient medical
  • 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
Outpatient medical
  • Ambulatory care planning (CP): Durable medical equipment
  • CP: Procedures

Plan types affected

This update affects inpatient and behavioral health authorizations for all product lines, including commercial group and individual plans, Medicare and Medicaid.

To learn more about the InterQual criteria, visit the Change HealthCare website.