Contact Us
Plans and Services Health and Wellness About Wellmark Member Employer Broker Provider
Home Provider Medical Policies and Authorizations
» Working with Wellmark.com 
» News
» BlueCard®
» Claims and Payment
» Medical Policies and Authorizations
» Health Management
» Credentialing and Contracting
» Medical, Dental, and Pharmacy
» Communications and Resources
» Quality and Transparency
» Health Care Reform for Providers
printer friendly Printer-Friendly Page
Transition to InterQual® Criteria

 

Download PDF of Fact Sheet

View Pre-Service Review Frequently Asked Questions 

How to Access InterQual Criteria

  • The InterQual criteria is available to clinicians through SmartSheetsTM on Wellmark.com.
  • The SmartSheets are secure content, so you will need to log in to view.
  • You will need to be assigned the Utilization Management Procedures & DME role to view the SmartSheets.
  • Your designated security coordinator (DSC) can assign this role, if appropriate.
  • View the SmartSheets .
  • DME providers and out-of-state providers can receive the SmartSheets via fax by calling 800-552-3993.

2014 McKesson InterQual Changes

InterQual® content is the most widely used, evidence-based clinical decision support for care management because of its sound clinical logic, which rests on a rigorous, comprehensive development cycle. Refined and proven over 30 years, this development cycle combines systematic, critical assessment of the medical literature by highly trained clinical development teams with feedback from an InterQual clinical panel of 1,100 experts.  InterQual® criteria, published by McKesson Health Solutions, is used in many of Wellmark’s medical review processes to support the medical necessity of health care services.  We are publishing the 2014 annual changes to the criteria for Providers to review prior to implementation.  These documents have been modified by Wellmark to reflect clinical revisions only for those items contained on the Wellmark Authorization table. 

                                                                                                      

Procedures 2014 Clinical Revisions

 

The revisions have been implemented as of August 9, 2014. As part of McKesson Health Solutions’ content release, coding changes have been made to the following services: bariatric surgery, hysterectomy, and ptosis repair. These changes have been added to the Wellmark Authorization Table. The 2014 InterQual® Criteria for all services requiring prior approval will be effective for any requests initiated on or after August 9, 2014 regardless of date of service.



Quick Links

» Authorization Table
» Credentialing Submission Tracker
» Drug Information
» Education
» Find a Doctor or Hospital
» Forms
» Health Care Reform
» ICD-10
» Medical Policies
» Provider Guides
» WINS
FacebookTwitterInstagrampinterestLinked InYou Tube