Medical Policies A-Z

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Medical Policies and Authorizations

Medical Policies A - Z

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»	Medical Policies A - Z

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»	InterQual® Criteria and SmartSheets^TM

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Medical Policies - Alphabetical Listing

View the Medical or Drug Authorization Tables to determine when to request an authorization.

InterQual® criteria is used to evaluate whether a medical procedure or equipment is medically necessary. Contracting practitioners can view InterQual criteria via SmartSheets^TM . DME providers and out-of-state providers can receive the SmartSheets via fax by calling 800-552-3993.

A

B

C

D

E

F

G

H

I

K

L

M

N

O

P

Q

Quantitative Sensory Testing

R

S

T

U

V

W

Y

Yescarta (Axicabtagene Ciloleucel)*