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Clinical criteria and guidelines used for determinations of medically necessary coverage decisions

August 14, 2020

As outlined in the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers (Hospital Manual), we would like to remind you that Independence uses the clinical criteria and guidelines set by InterQual®, a product of Change Healthcare, an independent company.

The InterQual clinical decision-support criteria model is based on the evaluation of intensity of service and severity of illness. Covered services for which InterQual criteria may be applied include, but are not limited to, the following:

  • home health care
  • inpatient hospitalizations
  • inpatient rehabilitation
  • long-term, acute care facility admissions
  • observation
  • some elective surgery for inpatient and outpatient procedures

In addition to the above criteria, Independence requires a consecutive stay period of at least 24 hours for an inpatient admission. For example, if a patient presents to the emergency room at 9:00 p.m. and leaves the facility at 11:00 a.m. the following morning, that is not considered an overnight stay since the time period did not reach 24 hours.

Emergency admissions

We apply acute-care guidelines, medical necessity/medical policy criteria, and medical judgment to evaluate medical appropriateness of Emergency admissions. Admissions that do not meet acute intensity of services and severity of illness guidelines are reviewed by an Independence Medical Director.

Learn more

For detailed information on clinical criteria and guidelines used for admissions, please refer to the Hospital Manual, which is available for participating providers in the Current Publications section on the Independence Plan Central page of the NaviNet® web portal (NaviNet Open).

NaviNet® is a registered trademark of NantHealth, an independent company.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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