Home health prior auth and InterQual® criteria requirements
We're introducing new prior authorization guidelines and InterQual® criteria for home health visits. Using InterQual® criteria will ensure the services our members receive align with the most current standards of care and best practices. We're confident that using InterQual® criteria will provide consistent, standardized, and evidenced-based guidance.
- As of Dec. 1, 2018, any prior authorizations requests for home health care will be subject to InterQual® criteria to ensure appropriate, quality care for all product lines.
- As of Jan. 1, 2019, all home health visits for Medicare and Medicaid members will require prior authorization before the first visit and will be subject to InterQual® criteria, Medicare guidelines, or the Medicaid provider manual. All commercial products will continue to be subject to InterQual® criteria for any prior authorization beyond 30 SN visits.
For more information about Home Health prior authorization and InterQual® criteria email homehealthcaremanagement@priorityhealth.com.
Questions?
Find more specific information on InterQual®.