InterQual content is the most widely used, evidence-based clinical decision support for case 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.
How to access InterQual criteria
The InterQual criteria is available to clinicians through SmartSheetsTM, found in the Wellmark Provider Portal.
Note: 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. DME providers and out-of-state providers can receive the SmartSheets via fax by calling 800-552-3993.Access Smartsheets Secure Site
The 2020 InterQual® criteria will be implemented on 12/07/2020. As part of Change Healthcare LLC content release, coding changes have been made to the following service: BRCA. The Wellmark authorization table will be updated accordingly on 12/07/2020 when the updated criteria is implemented. The 2020 InterQual® Criteria for all services requiring prior approval will be effective for any requests initiated on or after 12/07/2020 regardless of date of service.