Interqual level of care criteria 2010, acute care, adult. Mckessons interqual criteria portfolio helps support better patient outcomes through integrated, streamlined care management processes and evidencebased appropriateness of care decision support. The mckesson woundcare companion can help you and your clinical staff save time and money while providing the best care possible. June 20 and july 24, 2019 provider workshop mississippi medicaid. Forty years ago, interqual debuted as books that users would page through and annotate. In this free e book, our experts share the eight factors for success in the transition from feeforservice to valuebased care. Interqual evidencebased development change healthcare. Interqual guidelines download on free books and manuals search interqual level of care mckesson s interqual level of care criteria8 and millimans dec 17, 2018. What industry trends led to their creation, and what accounts for their longevity and widespread acceptance. Interqual behavioral health criteria support initial and continued stay level of care decisions across the behavioral health continuum of care. Included in the 2015 interqual release is new acute adult level of care criteria to address comorbid conditions on admission for patients with heart failure and copd. Change healthcare introduces interqual 2019 business wire. The interqual criteria provide support for determining the appropriateness of admission, continued stay and discharge for patients with multiple conditions or comorbidities.
Interqual level of care criteria are available for. Clinical resources to help improve the quality of care. Interqual actionable evidencebased criteria portfolio. Mckesson clinical resources mckesson medicalsurgical.
Advertisement mckesson interqual level of care criteria 20. Interqual level care criteria skip to main search results department. Longterm acute care medically complex respiratory complex ventilator weaning woundskin each admission request is evaluated individually to determine the appropriate level of care. The criteria address the varying needs of geriatric, adult, adolescent, and child patients with both psychiatric and substance use disorders. Mckesson interqual homecare criteria mckesson interqual imaging guidelines mckesson interqual level of care acute adult and pediatric, subacuteskilled nursing facility, long term acute care. Interqual level and related national uniform billing nub revenue code based on the table below. During the last three decades, these criteria have helped define and legitimize the disciplines of utilization and care management, providing medical directors.
The richness of clinical detail allows for consideration of. Mckesson medicalsurgical offers respiratory products including nebulizers, cpap supplies, endotracheal tubes, nasal cannulas, humidifiers, and medical supplies. Their purpose is to help you provide quality care by reducing inappropriate use of medical resources. Interqual care criteria guidelines learn how to have the answers for that interqual care criteria guidelines. Behavioral health, durable medical equipment, longterm acute care, outpatient rehabilitation, and chiropractic criteria are introduced and expanded. We greatly appreciate your business, and continually strive to ensure the quality of the products and services we provide to you and your organization. Thanks to the wide availability of the internet all over the world, it is now possible to instantly share any. Interqual criteria are produced using a rigorous development process based on the principles of evidencebased medicine ebm to give you complete confidence in the underlying guidance the criteria provide. For four decades, the interqual team has upheld the singular vision of improving patient outcomes by advocating and supporting evidencebased care. Download free e book pdf, 194 kb as the healthcare landscape continues to evolve, payers are requiring providers to shift the way they provide care and run their businesses. New and enhanced content is a hallmark of the interqual annual release. Interqual evidencebased criteria portfolio enabling shared.
You will be able to print these pages and insert them into your binders, replacing the current pages. Yamhill county care organization application oregon. The interqual content portfolio consists of four content suites. Medical policies and clinical utilization management. Apr 16, 2020 access your interqual criteria on your tablet or smartphone with a few swipes of your finger.
Clinical decision support solutions interqual change. So do not look around for the right diagnosis and treatment to make the patient meet criteria. Abebooks, an amazon company, offers millions of new, used, and outofprint books. To access your interqual content for use with interqual mobile, you will need to enter your interqual criteria licensing credentials. Interqual level of care criteria change healthcare. Blue cross blue shield of massachusetts is an independent licensee of the blue cross and blue shield association. Log in to use the interqual level of care criteria. Level of care, planning, and behavioral health criteriato help. The military health system selects mckessons interqual for. Careport care management first to support change healthcare.
Mckesson europe, owned by mckesson corporation, is a pharmaceutical wholesale and retail pharmacy leader focused on bringing better health to people across europe. Mckessons interqual criteria, the standard for evidencebased clinical decision support, is now accessible on demand through a new cloudbased implementation. Interqual means the mckesson product housed in tenets case management documentation system. Jun 21, 2007 cms does not mention interqual or any other level of care criteria in either definition. Interqual criteria are clinically based on best practice, clinical data and medical literature. A variety of clinical resources, including care management programs, infection control, and online education, help you address the clinical needs of your healthcare facility. Our four criteria suites provide comprehensive coverage for medical and behavioral health across all levels of care as well as ambulatory care planning. Interqual mobile for ios free download and software. Every day, the companys 39,000 employees serve more than two million patients and consumers across 8,100 owned and banner retail pharmacies. Apply to registered nurse manager, care manager, registered nurse case manager and more. Access the clinical information you need when and where you need it with the new interqual mobile app. With an outstanding track record, widespread adoption, and continual enhancement, interqual criteria are the standard for evidencebased clinical decision support.
Interqual level of care criteria, interqual behavioral health criteria, interqual. Hospitals frequently use level of care criteria as an objective tool to help make decisions regarding whether an individuals condition is severe enough, or the services provided are intense enough, to be admitted to a specific level of care. Interqual level of care criteria 2010, longterm acute care, adult. Interqual behavioral health criteria change healthcare. Interqual level of care criteria help healthcare organizations assess the safest and most clinically appropriate care level for more than 95% of reasons for admission. Interqual adds criteria for helping determine appropriate hospital discharge planning as well as pediatric. For certain services, we supplement the interqual criteria with our own medical and behavioral health clinical criteria. Hospitals, health systems, and managed care organizations. Sm registered and service marks of the blue cross and blue shield association. Mckessons interqual criteria, the standard for evidencebased. The conditionspecific format presents evidencebased interventions that are specific to the condition and help to costeffectively improve outcomes.
Our content development and updating approach involves a fivestep process. Mckesson health solutions has made significant changes to the interqual level of care criteria for 2016. Payers and providers can get anytime, anywhere access to interqual level of care criteria and interqual behavioral health criteria via ios apple or android smartphones or tablets. Interqual is intended for use as screening guidelines with respect to medical appropriateness of healthcare services. Interqual is utilized to provide objective feedback to physicians and hospitals on the patient status and level of care that may be appropriate for hospital patients.
Medical policies and clinical utilization management guidelines. Mckesson s interqual content portfolio helps support better patient outcomes through integrated, streamlined care management processes and evidencebased appropriateness of care decision support. They are updated continually and released annually. Findingsconclusions although the healthcare puzzle sometimes seems too. The same interqual criteria that youve always used can now be accessed with a few swipes of your finger. Please note that the these are suggestions based on interqual criteria and milliman criteria used by medicare, tenncare tenncare and most of the major payers. Interqual longterm acute care criteria blue cross will implement the 2019 interqual ltac criteria on aug.
Valuebased care services for specialty health mckesson. Mckessons interqual content portfolio helps support better patient outcomes through integrated, streamlined care management processes and evidencebased appropriateness of care decision support. The full list of medical policies and clinical utilization management um guidelines are publicly available on the medical policy and clinical um guideline subsidiary website. Additionally, for interqual level of care criteria book clients, we will upload a pdfformatted file of impacted criteria pages to the mhs customer hub and to mckesson download central in midaugust. Evidencebased criteriaguidelines utilization management.
Interqual evidencebased clinical decision support criteria are used by thousands of organizations in healthcare. The acute criteria address the observation, critical, intermediate, and acute levels of care and an additional 4 levels of nursery care in pediatrics. Interqual is to be used as an evidence based medical tool, where your patients either meet the criteria listed or they do not. The military health system has licensed all of the interqual level of care, behavioral health and care planning criteria. The first and most important thing to understand about interqual is that it is not your job to make patients meet criteria. Mckesson advanced diagnostics management dark daily. Interqual criteria are objective and specific to better help ensure the most appropriate care and more consistent, defensible decisionmaking. Procedures, imaging, specialty rx oncology, specialty rx nononcology, molecular diagnostics, and durable medical equipment products.
For blue cross members, pain management cant be used as a. Mckesson interqual level of care criteria 20 mckesson on. Online shopping from a great selection at books store. Interqual online, a mckesson hosted service, is an affordable, easytoimplement and easytouse application for accessing interqual criteria via the web in readonly mode. Interqual level of care criteria 2012, acute care adult mckesson health solutions llc on. Community health solutions makes the most of every healthcare dollar december 03, 2014 community health solutions of america chs is a nationally recognized provider of innovative and comprehensive medical care management services for a diverse client base serving more than 200,000 covered lives.
Help determine the appropriateness of admission, continued stay and discharge at. An enhanced digital version of the interqual content, interqual mobile offers you all the. On this date, the modification outlined below will take effect, and all previous modifications and interqual criteria will be replaced with this guideline. Utilization management criteria summacare healthcare. For example, the interqual criteria sets for see a random page in this book. Community health solutions makes the most of every. Interqual mobile offers you aroundtheclock access to the latest and most accurate clinical content at your fingertips. Change healthcare, an independent company, has made updates to the interqual criteria for 2019. Mckesson medicalsurgical delivers nutritional supplements and feeding supplies including ensure, dietary supplements, feeding tubes, baby formula, and more. Interqual mobile, the first mobile version of mckesson s interqual content, is now available at no additional cost. Interqual level of care criteria interqual care planning criteria.
Change healthcare interqual evidencebased criteria and technology solutions help improve clinical decisionmaking and care management across the medical and behavioral health continuums of care. Interqual s comprehensive portfolio includes five content suites. Charting guidelines attending physicians must write a progress note daily on a patients chart not just cosign a residents note. Interqual criteria for seven conditions that would be considered appropriate for management in the home at the acute level of care. Interqual level of care acute criteria adult 2004 mckesson on. Mckesson brings interqual criteria to the cloud business wire. Interqual criteria or mcg care guidelines are used only for. Review the criteria for the next steps of intensive treatment options. If a denial is issued by beacon, the rationale will be shared in the denial letter. Are hospitals bound by interqual criteria when determining. Substance use criteria will not be impacted asamlocadtrtcada or other state criteria remain the same.
In addition to comprehensive wound care resources, the woundcare companion also features information on nutrition and wound healing. Interqual level of care criteria 2010, acute care, adult on. Our innovative clinical content, technologies, solutions, and services have helped reduce the administrative burden, enhance payerprovider relations, and improve quality care. Access articles, resource guides, webinars and more to learn about todays key clinical topics. Mckesson interqual is an evidencebased clinical criteria that provides support covering medical and behavioral health across all levels of care as well as care planning and complex care management. Change healthcare interqual 2018 brings efficiency. Weve heard from you loud and clear that putting our interqual criteria on a mobile platform would give you the information you need when you. The interqual content portfolio consists of four product sets. This new criteria allows for appropriate admission of medically complex patients with comorbid conditions who may not otherwise meet criteria for the primary condition alone. Interqual level of care criteria 2012, acute care adult. Mckesson interqual training download on free books and manuals search interqual behavioral health adult psychiatry criteria 2014 mckesson health solutions has introduced interqual 2015, the latest edition of the companys decisionsupport solution. Mckesson interqual level of care criteria 20 ringbound january 1, 1900 by mckesson author see all formats and editions hide other formats and editions. Interqual 2014 release raises the bar for evidencebased clinical content at the point of care. Interqual mobile, the first mobile version of mckessons interqual content, is now available at no additional cost.
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