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  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 05/12/04

 

InterQual Criteria

To:​

Enrolled Hospitals – Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers and Utilization Review Departments ​
Date:​ May 12, 2004​
Re:​

InterQual Criteria ​

 

 

Effective immediately, HealthSystems of Illinois (HSI), the federally designated Peer Review Organization (PRO) for the department, will utilize the most current version of InterQual Criteria (currently 2003) to determine the medical necessity of inpatient hospital admissions and continued stay reviews for patients presenting with a medical/surgical diagnosis.

 

 

The InterQual Criteria is usually released during the second quarter each year. Prior to implementing new versions of the InterQual Criteria, HSI will send a Provider Update bulletin to all hospital Medicaid liaisons advising them of the implementation date of the new criteria. This Provider Update bulletin will also be posted on HSI’s Web site

If you have any questions regarding this notice, please contact the Bureau of Contract Management at 217-524-7478.

 

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs