Inpatient admissions policy change


Effective June 1, 2017, Priority Health is instituting an inpatient admissions policy change. We will apply InterQual® hospital admissions criteria at 24 hours for patients. This will apply to all our products and aligns with our current policy for Medicaid and Medicare members.

InterQual® ISD criteria are clinically based on best practice, clinical data and medical literature. They are updated continually and released annually. Decisions made using this criteria are based on each patient's clinical status and rely on patient-specific clinical indicators, service requirements and discharge/transfer readiness.

Facilities must notify us around the 24-hour mark

Facilities must notify us around 24 hours following hospital admission, once the patient's clinical status has been assessed, treated and reassessed, to determine admission bed status. This period of assessment allows adequate time to verify if the patient's condition has stabilized and to determine if they are an inpatient admission or will remain in observation.

Care management admissions assistance available

Priority Health Care managers are available to support the assessment of admission (bed type) appropriateness, and to assist with discharge planning once the patient has been stabilized and is ready for transition to the next most appropriate level of care. For more information contact the care management team at 800.998.1037.