Determinations on requests for inpatient acute care admissions are based on InterQual^® criteria, not on the two-midnight rule

The Blue Cross / Blue Care Network Utilization Management department makes determinations on authorization requests for inpatient acute care admissions based on InterQual criteria, not on the two-midnight rule.

This applies to admissions of members covered by all our lines of business.

We're clarifying this because we recently received some questions from providers about the two-midnight rule.

Providers should do the following:

• Refer to the InterQual criteria for the type of admission and to the associated Blue Cross and BCN Local Rules.

  Note: The Local Rules are available on this website, on the Blue Cross Authorization Requirements & Criteria page and the BCN Authorization Requirements & Criteria page.

• Disregard any information about the two-midnight rule that we may have published in past communications, since that information is no longer current.

We're updating the pertinent provider manuals to include a statement clarifying that we do not use the two-midnight rule in making determinations on authorization requests for inpatient acute care admissions.

Posted: June 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network