We're updating to InterQual 2019 for inpatient and behavioral health authorizations starting July 12, 2019

To continue to better serve you while ensuring our members are getting the right care, at the right place, at the right time, we’re updating to InterQual® 2019 on July 12, 2019, for inpatient medical and behavioral health authorizations.

Why are we upgrading to 2019 InterQual?

InterQual’s content has been updated to reflect the most recent evidence and clinical standards.

As a result of this transition, the following InterQual subsets will be updated:

Behavioral Health - InterQual subsets
Adult and geriatric psychiatry
Child and adolescent psychiatry
Substance use disorders
Procedures
  • Autism
  • Transcranial magnetic stimulation (TMS)
Inpatient medical - InterQual subsets
Level of care (LOC): Acute adult
  • Several new condition subsets were added and acute level of care criteria was shifted to observation level of care
LOC: Acute pediatric
  • Several new condition subsets were added and acute level of care criteria was shifted to observation level of care
LOC: Rehabilitation
LOC: Subacute/Skilled nursing facility
LOC: Home care Q&A
LOC: Long term care acute

Plan types affected

This update affects inpatient and behavioral health authorizations for all product lines, including commercial group and individual plans, Medicare and Medicaid.

To learn more about the InterQual criteria, visit the Change HealthCare website