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Coverage policy and pre-certification/pre-authorization

Coverage policy and pre-certification/pre-authorization information for out-of-area members.

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InterQual® Coverage Policy Guidelines

The InterQual® guidelines are used by our utilization management team to help assess whether a given medical condition and known or represented circumstances of a case support medical service(s) as the most appropriate treatment, or whether the medical condition/circumstances presented could be appropriately addressed with an alternative treatment. Use the self-registration tool at the link to create a login and view the criteria. Individuals without an email address should contact the plan to receive the criteria information via mail.

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Providers' News

Find updates on the latest policies and procedures for providers.

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Personal Health Record (PHR)

A confidential, electronic medical record with information available from medical claims and testing, combined with information provided by the patient.

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