In June we advised that the Clinical Services – Utilization Management department at AmeriHealth would begin using the 2017 McKesson InterQual Level of Care Criteria on August 28, 2017. However, there was a delay in the implementation, and AmeriHealth did not begin using the guidelines at that time.

Effective December 18, 2017, AmeriHealth will begin using the updated guidelines for review of acute inpatient, acute rehabilitation, skilled nursing facility, and long-term acute care admissions. In addition, we will transition to the 2017 home care guidelines. AmeriHealth has been using corporate medical policies for guidelines for elective services requiring precertification.

If you have not previously done so, you can view a summary of the changes online for AmeriHealth New Jersey and AmeriHealth Pennsylvania.

For detailed information on the 2017 InterQual guidelines, please visit the McKesson Health Solutions website and search InterQual.