Transition to InterQual® Criteria

InterQual Fact Sheet

 

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View Pre-Service Review Frequently Asked Questions 

Prior Approval Update

Prior approval procedure and medical policy transition implementation dates have been updated.

 

Effective with date of service December 15, 2013 and after, the procedure below will be added to the prior approval list, and InterQual criteria will be used for this procedure. The medical policy will be removed and the Wellmark Authorization Table updated to allow authorization requests for this procedure to be accepted via the on-line Utilization Management Tool beginning December 1, 2013.

  • Capsule Endoscopy

Additionally, the following medical policies will be transitioning to InterQual criteria on December 1, 2013. These services are currently on the prior approval list.

  • Autologous Hematopoietic Stem Cell Transplant
  • Allogeneic Hematopoietic Stem Cell Transplant

To help you prepare for these transitions, the InterQual criteria (SmartSheetsTM) for all of the above will be available for practitioners to view on November 1, 2013. Links the SmartSheets appear on the Pre-Service Review Changes page.

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.
 
 
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