2018 InterQual® criteria implementation delayed until Aug. 6
We communicated in June that Blue Cross Blue Shield of Michigan and Blue Care Network would implement the 2018 InterQual criteria and local rules starting Aug. 1, 2018, for all levels of care.
However, the implementation of the 2018 criteria was delayed. The new implementation date is Aug. 6.
Until that date, the 2017 InterQual criteria and local rules will continue to be used in making utilization management and care management determinations for the services subject to review.
This affects both behavioral health and non-behavioral health services for the following lines of business, unless otherwise noted:
- Blue Cross PPO (commercial)
- Blue Cross Medicare Plus BlueSM PPO
- BCN HMOSM (commercial)
- BCN AdvantageSM
Note: Determinations on Blue Cross PPO (commercial) behavioral health services are handled by New Directions, a Blue Cross vendor, and are not affected by these criteria changes.
In addition, the e-referral system won't be available from 6 p.m. on Friday, Aug. 3 through 6 a.m. on Monday, Aug. 6, while it's being updated with the new criteria. Here's some information on how to process certain requests while the e-referral system is down:
- For urgent acute inpatient requests that need to be processed within 24 hours, call the appropriate number below:
- For Blue Cross requests, call the critical phone line at (313) 448-3619.
- For BCN requests, call 1-800-392-2512.
- For BCN post-acute and concurrent admission reviews, follow the current process you use to submit these requests by fax at 1-866-534-9994.
- For behavioral health requests, call the appropriate number below:
- For BCN behavioral health requests, call 1-800-482-5982.
- For Blue Cross Medicare Plus Blue PPO behavioral health requests, call 1-888-803-4960.
- For non-urgent authorization requests: Please wait to submit those until the e-referral system is available again.
Posted: July 2018
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network