United Healthcare Interqual Policy

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Clinical Guidelines UHCprovider.com

(4 days ago) WebUnitedHealthcare uses evidence-based clinical guidelines from nationally recognized sources during review of our quality and health management programs. Recommendations contained in clinical practice guidelines are not a guarantee of …

https://www.uhcprovider.com/en/policies-protocols/clinical-guidelines.html

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UnitedHealthcare Commercial Medical & Drug Policies

(7 days ago) WebA monthly notice of recently approved and/or revised Medical Policies and Medical Benefit Drug Policies is provided below for your review. We publish a new announcement on the …

https://www.uhcprovider.com/en/policies-protocols/commercial-policies/commercial-medical-drug-policies.html

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June UnitedHealthcare News: Reminder: We Transitioned to …

(3 days ago) WebAs previously announced, UnitedHealthcare transitioned to evidence-based InterQual® clinical criteria to support utilization management, beginning with dates of …

https://www.hbma.org/news/commercial-payor-news/insurance-company-news/united/n_june-unitedhealthcare-news-reminder-we-transitioned-to-interqual-on-may-1

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Medical Policy Update Bulletin: June 2022 - Center Care

(Just Now) WebInterQual® Release Dates Removed. Effective Jun. 1, 2022, all references to specific InterQual® release dates will be removed from the Medical Policies, Coverage …

https://centercare.com/_uploads/medical-policy-update-bulletin-june-2022-UHC.pdf

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UnitedHealthcare shifts to InterQual guidelines AppriseMD

(4 days ago) WebThere is a seismic shift happening in Utilization Review: As of Saturday, May 1, 2021, UnitedHealthcare, the country’s largest healthcare insurance provider, is changing …

https://apprisemd.com/a-quiet-shift-that-could-shake-up-hospital-utilization-review/

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MyUHC - Coverage & Benefits UnitedHealthcare

(4 days ago) WebView tools we use to administer your health plan. Our Medical & Drug Policies and Coverage Determinations Guidelines are tools we use to help us administer health …

https://member.uhc.com/coverage/medical-reimbursement/

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Level of Care Criteria InterQual® Change Healthcare

(5 days ago) WebExplore related solutions . InterQual® Coordinated Care Discover our cloud-based care coordination solution that helps with complex care management of high-risk members …

https://cs-gw-www.staging.changehealthcare.com/clinical-decision-support/interqual/level-of-care-criteria

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Hospital Services: Observation and Inpatient

(1 days ago) WebClick here to view the InterQual® criteria. Observation services are considered medically necessary for a member who requires the following care in any location within a hospital: …

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/hospital-services-observation-inpatient.pdf

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Letter to DOJ Antitrust Division on UnitedHealth Group’s …

(5 days ago) WebChange Healthcare currently owns the InterQual dataset, and UnitedHealthcare has moved to InterQual from the only comparable competitor, MCG …

https://www.aha.org/lettercomment/2021-08-04-letter-doj-antitrust-division-unitedhealth-groups-proposed-acquisition

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Clinical Development Process 2023 - InterQual®

(4 days ago) WebStep 1: Research. The InterQual clinical development team uses a systematic and continuous review of the published medical and behavioral health literature, combined …

https://prod.cue4.com/help/InterQualOnline/IntegratedHelp/content/pdf/interqual%20development%20process%202023.pdf

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Hospitals: UHC's MA policy 'blatantly violates' CMS requirements

(7 days ago) WebUHC, the largest MA provider in the country, outlined its use of the proprietary, nonpublic InterQual criteria and other UHC commercial medical policies in …

https://www.fiercehealthcare.com/payers/hospitals-uhcs-2024-ma-coverage-policy-blatantly-violates-new-cms-coverage-requirements

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InterQual ® Level of Care Criteria - Change Healthcare

(1 days ago) WebInterQual Acute Care Criteria. Specific and objective evidence-based criteria for admission and level of care. Directs to observation status for select conditions. Integrates …

https://www.changehealthcare.com/clinical-decision-support/interqual/level-of-care-criteria

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InterQual ® Solution - Change Healthcare

(8 days ago) WebEvidence-based criteria. InterQual criteria developed using evidence-based rigor and peer-review standards. Proprietary benchmarks for Length of Stay and Percent Paid as …

https://www.changehealthcare.com/clinical-decision-support/interqual

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UnitedHealthcare Partnership with naviHealth

(8 days ago) Webincludes the CMS Medicare Benefit Policy Manual Chapter 7 criteria for home health and InterQual® criteria. All potential denials receive physician review. Q19 What are the …

https://storage.googleapis.com/navihealth-prod-storage/partner/uhc-homehealth/document/frequently-asked-questions/46828cf1319bba96df160e2806b75a2b36a54e2a.pdf

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Continuous Glucose Monitoring and Insulin Delivery for …

(6 days ago) WebThe following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. Listing of a code in this policy does not imply that the …

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/continuous-glucose-monitoring-insulin-delivery-managing-diabetes.pdf

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InterQual® Technology InterQual® Change Healthcare

(9 days ago) WebStreamline the medical review and prior auth process with the interactive Medical Review Service SaaS solution integrated into your existing UM/CM system. Use our InterQual …

https://www.changehealthcare.com/clinical-decision-support/interqual/interqual-technology

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We’ll use updated 2023 InterQual criteria starting Feb. 1

(9 days ago) WebOn Feb. 1, 2024, Blue Cross Blue Shield of Michigan and Blue Care Network will start using updated 2023 InterQual. criteria to make determinations on prior …

https://providerinfo.bcbsm.com/documents/alerts/2023/202310/alert-20231018-feb-1-2024-updated-iq-criteria.pdf

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Hysterectomy – Commercial and Individual Exchange Medical …

(4 days ago) WebA hysterectomy is a surgical procedure to remove the uterus, and in some cases, the ovaries, and fallopian tubes as well. In a total hysterectomy, the entire uterus, including …

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/hysterectomy.pdf

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HHS Issues New Rule to Strengthen Nondiscrimination Protections …

(Just Now) WebDownload the News Release Download the News Release - Word. Today, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) …

https://www.hhs.gov/about/news/2024/04/26/hhs-issues-new-rule-strengthen-nondiscrimination-protections-advance-civil-rights-health-care.html

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InterQual® Optimization Solutions Change Healthcare

(1 days ago) WebExplore related solutions . InterQual Discover InterQual®, an evidence-based clinical decision support solution that helps healthcare organizations make appropriate medical …

https://www.changehealthcare.com/clinical-decision-support/interqual/optimization-solutions

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Surgery of the Hip - UHCprovider.com

(3 days ago) WebCoverage Rationale. Surgery of the hip and surgical treatment for femoroacetabular impingement (FAI) syndrome is proven and medically necessary in certain …

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/surgery-hip.pdf

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Sacroiliac Joint Interventions - UHCprovider.com

(2 days ago) WebSacroiliac Joint Fusion (SIJF) is a surgical procedure, which fuses the iliac bone (pelvis) to the spine (sacrum) for stabilization. It is performed for a variety of conditions including …

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/sacroiliac-joint-interventions.pdf

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