We're using updated utilization management criteria for non-behavioral health services starting Aug. 2, 2021
On Aug. 2, 2021, we'll begin using the 2021 InterQual® criteria to make utilization management determinations for non-behavioral health services.
In addition, certain types of determinations will be based on modifications of InterQual criteria or on local rules.
These changes will affect utilization management determinations for these members:
- Blue Cross Blue Shield of Michigan commercial
- Medicare Plus BlueSM
- Blue Care Network commercial
- BCN AdvantageSM
In early July, we'll have links to the updated versions of the modified criteria and local rules on this website, on these pages:
- Blue Cross Authorization Requirements & Criteria page
- BCN Authorization Requirements & Criteria page
For additional information about these changes, look for articles in the July 2021 issue of The Record and the July-August 2021 issue of BCN Provider News.
Posted: May 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network