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InterQual® Criteria and SmartSheets™

• How to Access InterQual Criteria
• 2018 Change Healthcare LLC InterQual Changes

How to Access InterQual® Criteria

• The InterQual criteria is available to clinicians through SmartSheets^TM 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.

2018 Change Healthcare LLC 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 Change Healthcare LLC, is used in many of Wellmark’s medical review processes to support the medical necessity of health care services. We are publishing the 2018 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.

• 2018 Imaging Clinical Revisions
• 2018 Procedures Clinical Revisions  
• 2018 Molecular Diagnostics Clinical Revisions  

The 2018 InterQual^® criteria will be implemented on 10/13/2018. As part of Change Healthcare LLC content release, coding changes have been made to the following service: Sclerotherapy, Varicose Veins. The Wellmark Authorization table will be updated accordingly to reflect these changes. The 2018 InterQual^® Criteria for all services requiring prior approval will be effective for any requests initiated on or after 10/13/18 regardless of date of service.