We're using updated utilization management criteria for behavioral health starting Aug. 1, 2019
On Aug. 1, 2019, Medicare Plus BlueSM PPO, Blue Cross Blue Shield of Michigan's Medicare Advantage plan, and Blue Care Network's commercial and Medicare Advantage plans (BCN HMOSM and BCN AdvantageSM) will begin using the 2019 InterQual® criteria for behavioral health utilization management determinations.
In addition, certain types of determinations will be based on modifications to InterQual criteria or on local rules or medical policies, as shown in the table below:
|Line of business
|Modified 2019 InterQual criteria for:
|Local rules or medical policies for:
|BCN HMO (commercial) and BCN Advantage
|Medicare Plus Blue PPO
Note: Determinations on Blue Cross PPO (commercial) behavioral health authorization requests are handled by New Directions, a Blue Cross vendor.
Posted: May 2019
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network