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Evidence-Based Criteria/Guidelines | Utilization
InterQual Criteria InterQual Criteria are objective and specific to better help ensure the most appropriate care and more consistent, defensible decision-making. Our four criteria suites provide comprehensive coverage for medical and behavioral health across all Location: 3055 Lebanon Pike Ste 1000, Nashville, 37214, TNLogin · Interqual Level of Care Criteria · Criteria Powered by InterQual · Interqual Education[PDF]
2018 InterQual guidelines - provcommihealth
2018 InterQual® guidelines Below is a summary of the changes included in the April 2018 InterQual Criteria release that AmeriHealth New Jersey will begin using on August 20, 2018.[PDF]
Medical Necessity & Charting Guidelines
Rather, chart “patient to IMCU soon”. The first entry will qualify as a non-acute ICU bed day. Avoid charting “patient doing well, will discharge in a.m.” This denotes that the patient no longer meets “severity of illness” criteria to warrant his/her stay in an acute care facility.[PDF]
InterQual Criteria Overview - Decision Management
InterQual Criteria are produced using a rigorous development process based on the principles of evidence-based medicine (EBM).
InterQual LOC criteria | Priority Health
InterQual ® criteria are a first-level screening tool to assist in determining if the proposed services are clinically indicated and provided in the appropriate level or whether further evaluation is required. The first-level screening is done by the utilization review nurse.
InterQual® Criteria and Medicare Guidelines – Update for
Jul 01, 2015InterQual criterion is developed via a rigorous assessment and review process, performed by a panel of over 750 board certified clinical experts from various disciplines. Reference sources for criterion include CMS, SAMHSA, NCQA, and other national evidence based guidelines.[PDF]
Behavioral health utilization management criteria (Local
These local rules apply to all BCN HMO (commercial) members statewide whose care is coordinated by BCN’s Behavioral Health department. The following local rules for service requirements were developed or revised for use with InterQual’s Child/Adolescent Psychiatry – Residential Treatment Center criteria:[PDF]
Behavioral health utilization management criteria (local
In applying InterQual ® 2018 criteria to different benefit packages, Blue Cross Blue Shield of Michigan and Blue Care Network have adopted local rules. These local rules apply to all BCN HMO (commercial), BCN Advantage and Medicare Plus Blue members statewide whose care is People also askWhat does InterQual criteria mean?What does InterQual criteria mean?Interqual is a set of criteria used to determine if a patients hospital length of stay is appropriate. The criteria is based on the diagnoses and any treatments involved in the patients care. It is a guideline used by IPA's that are supposed to save money by preventing unnecessary bed days.Interqual? | allnursesSee all results for this questionHow to learn InterQual?How to learn InterQual?Interqual has the book (which is updated constantly) built into the system. References, resources, ebook, help, and glossary are all located in the Interqual system. The paper book will be outdated by the time you get your hands on it So use your Interqual software to review the book. If you have no idea what I am writing,..Learning Interqual - Nursing ForumSee all results for this questionAre evaluation criteria required?Are evaluation criteria required?As a best practice, NITAAC recommends providing the award evaluation criteria in all solicitations, and under FAR 16 (b) (1) (iii), an evaluation criteria is required where the anticipated value of the award is expected to exceed $5M.Are evaluation criteria required? | NITAACSee all results for this question
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