BCN Behavioral Health utilization management criteria is changing on January 1
Effective Jan. 1, 2016, BCN Behavioral Health utilization management criteria are changing as outlined here.
InterQual® criteria. BCN will use McKesson's InterQual Behavioral Health Criteria as utilization management guidelines. InterQual criteria are evidence-based clinical support criteria specifically developed to help move patients safely and efficiently to the appropriate initial and subsequent level of care. The criteria require reviewers to consider the severity of illness as well as episode-specific variables that match the level of care to a patient's current condition.
InterQual Behavioral Health criteria are developed with evidence-based rigor and are validated through the expertise of a multidisciplinary panel of psychiatrists, psychologists, psychiatric nurses and social workers. McKesson comprehensively reviews medical literature and other respected sources to assure that the criteria are current with the latest advances in evidence-based medicine as well as with new terminology and diagnostic classifications.
Providers may request a copy of the specific InterQual criteria used to render a decision on a member's case. To purchase a copy of the InterQual Behavioral Health criteria, call the InterQual Support unit at McKesson Health Solutions at 1-800-274-8374.
BCN's local criteria. In addition, BCN Behavioral Health will continue to use its own, local utilization management criteria for decisions about specific services, as follows:
- Transcranial magnetic stimulation criteria
- Neurofeedback training criteria for attention deficit disorder / attention deficit hyperactivity disorder criteria
- Autism spectrum disorder / applied behavior analysis criteria
- Residential mental health services / adult, adolescent and child criteria
Behavioral Health develops the criteria used for making medical necessity determinations in these areas. National experts, clinical advisory committees and contracted behavioral health clinicians contribute to the development of these criteria. The criteria are reviewed and updated, if appropriate, at least annually and are presented at the Clinical Quality Committee for physician input and approval. Scientific resources for the internal criteria include:
- Diagnostic and Statistical Manual of Mental Disorders
- Peer-reviewed scientific literature
- Available nationally recognized clinical guidelines
These local criteria will be available by January 1 on the Behavioral Health page on this website.