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InterQual Provider TrainingTraining will begin at 3:03PM EDT to allow everyone to sign into the webinarSeptember 20191

Agenda1What is InterQual?2Outpatient3Inpatient4Additional Procedures5Important Information6Questions?2

Chapter01InterQualTransparency Tool“We help people livetheir lives to thefullest potential.”Our Commitment3

What is InterQual?Effective Sept. 21, 2019, Beacon will begin using Change Healthcare’s InterQual medicalnecessity criteria.Using nationally recognized criteria is consistent with mental health parity requirements.Beacon is committed to strengthening and enhancing clinical quality by leveraging this bestin-class, evidence-based criteria.4

What is InterQual? Evidence-based, nationally used criteria across healthcare (Physical Health, Behavioral Healthand Substance Abuse) InterQual criteria are derived from the systematic, continuous review and critical appraisal ofthe most current evidence based literature and include input from their independent panel ofclinical experts Criteria is reviewed and updated annually InterQual is intended for use as screening guidelines with respect to medical appropriatenessof healthcare services. Substance Use criteria will not be impacted (ASAM/LOCADTR/TCADA or other state criteriaremain the same).**If a denial is issued by Beacon, the rationale will be shared in the denial letter. Denials arebased on a medical necessity review by a Physician and not solely on InterQual criteria.5

What is InterQual?Accounts that require use of state-specific or other medical necessity criteria are NOT impacted.Other processes and workflows remain the same (such as authorization process); only the criteriaare changing.Providers will not be submitting authorization requested through InterQual. Beacon’s authorizationprocess will remain the same.6

Plans not moving to InterQualAffinityMetroPlusAmida CareMVP HealthCareCrystal RunSenior Whole Health NYCTBHP Connecticut Behavioral Health PartnershipValue Behavioral Health of Pennsylvania (VPH PA)Elder PlanVisiting Nurse Service Choice (VNS) MedicareEmblem Health and Group Health Incorporated (GHI)Visiting Nurse Service Choice (VNSNY) Choice SelectEmpireYourCare Health PlanHamaspikBCBS Tennessee (Tenncare) After hours planHealth First (ABA only)Better Health AmerigroupHorizon BlueCross- BlueShield NJ Commercial/Gov’tCare Source KY (HSCKY)iCircleIndependent Health (IHA)Clear Healthcare- AmerigroupGeorgiaMarylandKansas Department of Aging and Disability ServicesFederal Block Grant/Problem Gambling FundMichigan LRENC Health ChoicesNC PSDKansas Sentencing CommissionSimply HealthcareFresno CountyPassport AdvantageHMSA (Commercial/Medicaid/Medicare)Shasta CountyOCMHP7

InterQual Transparency beacon/handbook/clinical-criteria/Navigate your browser to the link listed above to access InterQual Medical Necessity Criteria8

InterQual RegistrationRegistration is required to view the criteria.This is a separate login fromProviderConnect or eServices.You will need to enter the following toregister: Email address Password First name Last nameOnce completed, click on Register.9

InterQual LoginOnce registration has been completed, proceed to the login link.Enter your email address and password to login.10

Password recoveryFor password recovery, enter your email address, then click recover my password.An email will then be sent you with your password.11

InterQual Transparency tool12

InterQual Transparency ToolBegin your navigation by clicking on Select Product. This will open a dropdown menu. Select the appropriate product from there.13

InterQual Transparency ToolMake sure you are selectingup to date criteria14

InterQual Transparency ToolClick hereSelect the category. You may choose All Categories or the appropriate category based on the subsetyou selected. Click on the subset after you have chosen the category.15

InterQual Transparency ToolPlease review the subset notes16

InterQual Transparency ToolClicking on Show Codespopulates a list of applicableICD-10 codes relative to the subsetyou select.17

InterQual Transparency ToolClicking on the ClinicalReference link will bringyou to a list of .pdfreference documents.These materials can bedownloaded and saved toyour computer for futurereference.18

InterQual Transparency ToolYou have the ability to print and save thefull subset of criteria.At the bottom of your screen you will seethe links shown on the left.These also allow you to bookmark the subset,or, change the subset if needed.19

InterQual Transparency ToolClick on Book View to advance into the criteria20

Chapter02Outpatient“We help people livetheir lives to thefullest potential.”Our Commitment21

InterQual Transparency ToolSelect the appropriate criteria from thedrop down menu to proceed.As shown on the screen, multiple optionsare available to review.Make sure to select the appropriatecriteria.22

InterQual Transparency ToolClick on the note to review theinformational note for outpatientservices.23

InterQual Transparency ToolUse the Expand All feature, to openall of the criteria at the same time.This will open all the plus signs withassociated criteria.24

InterQual Transparency ToolUsing the Collapse All option willclose all open criteria.25

InterQual Transparency Tool Day OneClick on the plus ( ) symbol to openthe criteria subsets26

InterQual Transparency Tool Day OneYou are able to review the criteria for Outpatientservices.The plus ( ) symbol will show the criteria foroutpatient admissions by category and inalphabetical order.symbol indicates the member needsto meet one, or more, of those criteria.27

InterQual Transparency Tool Day Two OnwardFor continued outpatient treatment, open the plussign for Episode Day 2-X.If they are improved and discharged from treatmentyou will not need to advance.If they have ongoing symptoms, continue to advanceand review the criteria.28

InterQual Transparency Tool Day Two OnwardIf the member’s symptoms continueto worsen, they may require amore intensive level of care.Review the criteria for the nextsteps of intensive treatmentoptions.29

InterQual Transparency Tool Children and AdolescentsCriteria and subsets for outpatient are available forchildren and adolescents as well.Please note the informational notes for children30

InterQual Transparency Tool Children and AdolescentsNavigating the criteria for Childrenand Adolescents is the same asAdults and Geriatrics.31

InterQual Transparency ToolClicking on Change Subset willRe-set your selections whileremaining within the originalsubset selected.32

Chapter03Inpatient“We help people livetheir lives to thefullest potential.”Our Commitment33

InterQual Transparency ToolSelect the appropriate criteria from thedrop down menu to proceed.As shown on the screen, multiple optionsare available to review.Make sure to select the appropriatecriteria.34

InterQual Transparency Tool Day OneClick on the plus ( ) symbol to openthe criteria subsets35

InterQual Transparency Tool Day OneYou are able to review the criteria for Inpatientservices.The plus ( ) symbol will show the criteria forInpatient admissions by category and inAlphabetical order.symbol indicates the member needsto meet one, or more, of those criteria.36

InterQual Transparency ToolUse the tool to assess the members current clinical information.Click on the note for additional details or clarification.37

InterQual Transparency ToolInformational notes are listed throughoutthe InterQual criteria.These provide valuable information andclarifying details.38

InterQual Transparency ToolIn addition to the informational notes, care management notes, are also available.You will see them highlighted in turquoise. Click on the note for the details.39

InterQual Transparency ToolUse Expand All to open all of thecriteria for the category you selected.40

InterQual Transparency Tool Continued StayIf the member isresponding to treatmentand clinically stable fordischarge, go to therecommended level ofcare.41

InterQual Transparency ToolIf the member has improving symptoms, but not stablefor discharge, open the finding or interventions andreview the criteria.Use the same process for episodes day 14 and beyond.42

InterQual Transparency ToolClicking on Collapse All will collapse all of thecriteria.This can be helpful if you have opened all of thecriteria, and need to start over.43

InterQual Transparency ToolBenchmarks will show the length of stay, based onthe member’s presenting condition, using theInterQual criteria.44

Chapter04AdditionalProcedures“We help people livetheir lives to thefullest potential.”Our Commitment45

InterQual Transparency ToolAdditional procedures can be found under Procedures Q & A.46

InterQual Transparency ToolIf Psychological Testing in required, review the subsetnotes before proceeding to Book View.47

InterQual Transparency ToolChoose all that apply or selectnone of the above.Select the reason for testingchoose all that apply.Click next to continue48

InterQual Transparency ToolContinue to select the choices that applyto the condition the member is presenting with.Select the appropriate age range.49

InterQual Transparency ToolConfirm if the parent or guardian has been interviewed,and if any behavioral related disturbances have beensuspected or confirmed.After completing the review of criteria, click onView Recommendations.50

Chapter05ImportantInformation“We help people livetheir lives to thefullest potential.”Our Commitment51

System RequirementsCan I use a modem, or dial-up connection to access InterQual?No, you cannot access InterQual using a dial-up connection.Can I use the Safari browser to login to InterQual?No, you cannot use the Safari browser to login to InterQual. The Safari browser is the native browser oniPhones, iPads, and other Apple products.Please use one of the following recommended browsersInternet Explorer 11Google ChromeMozilla FirefoxCan I use my Beacon ProviderConnect or eServices credentials to login to InterQual?No. You must register with InterQual through the Beacon website and use your InterQual credentials tologin.52

System RequirementsCan I submit authorization requests through InterQual?No. The Beacon authorization process remains the same.After 15 minutes of inactivity, the session will time out You will need to log back into the session If you have timed out, the session will not save the information If a denial is issued, the rationale will be shared in the denial letter. Denials are based on a medicalnecessity review by a Physician and not solely on InterQual criteria.53

Provider Resources Providers can access reference materials and tools on the Beacon healthOptions website: on/ Available resources include: Provider ManualsClinical GuidelinesProvider AlertsProvider TrainingResource guides for claims, authorizations, EFT, and how to contact us54

Contact InformationBeacon HealthStrategiesWebsite and EDIPaySpanCredentialingand ContractingBeacon Health OptionsEDI HelpdeskMonday through Friday,8 a.m.-6 p.m. ETPhone: comPayspan Registration Provider SupportMonday through Friday,8 a.m. – 8 p.m. ETPhone: e to locate your registration mReply will be received within three business daysNational Provider Services LineMonday through Friday,8 a.m.-8 p.m. ETPhone: 800-397-1630Regional Provider Relations Team55

Questions?56

5 What is InterQual? Evidence-based, nationally used criteria across healthcare (Physical Health, Behavioral Health and Substance Abuse) InterQual criteria are derived from th