Important 2022 updates to our prior authorizations

In July, we shared plans to move musculoskeletal (MSK) services to InterQual® criteria. In addition, there are a couple other changes happening Jan. 1, 2022.

What’s changing

As of Jan. 1, 2022, we’ll launch the following updates to our prior authorizations:

• MSK services will move to prior authorization using nationally recognized 2021 InterQual criteria
• Outpatient elective services will transition from 2020 InterQual criteria to 2021 criteria
• We’ll transition from the 2020 CMS Inpatient Only list to the 2022 list (Medicare only)

What you need to know

There are no changes to how you submit your authorizations. The new criteria will be uploaded in our GuidingCare tool and when appropriate you’ll be prompted to answer InterQual questions just like you are today.

The 2022 CMS Inpatient Only list applies to services received by our Medicare members. All other members are not applicable to this change.