Update to 2013 McKesson InterQual Criteria Sheets and Prior Authorization (PA) Changes, CR 37411

April 1, 2014

Effective today, March 25, 2014, certain McKesson InterQual Criteria Sheets have been updated from the current version on the Health PAS Online Portal to the 2013 version and will be used as guidelines to approve or deny PA requests. Please note that for a short time, we will continue to accept PA requests with the older versions of the criteria sheets concurrent with the newer versions. We will notify you when we are no longer accepting the old forms.

With the adoption of the 2013 McKesson InterQual Criteria Sheets, MaineCare is also changing the process for submitting PAs. You no longer need to include the full criteria sheet in your submission to MaineCare. Instead, you must print, sign, date, and submit the first page of the criteria sheet, indicating the relevant clinical scenario number, and print only the completed clinical scenario sheet for the scenario that applies.

The 2013 McKesson InterQual Criteria Sheets can be accessed by logging into your Trading Partner Account on the Health PAS Online Portal and clicking on the Prior Authorization Document Library, and then on the Provider Prior Authorization Folder.

Reminder: There may be codes on McKesson’s InterQual Criteria Sheets that are not covered by MaineCare.

A new Prior Authorization Request form is also available. Please submit the new form with the criteria sheets. You can access the Prior Authorization Request form in the Authorizations and Referrals folder, on the Health PAS Online Portal.

If you have questions about the PA process, McKesson InterQual Criteria Sheets, or to verify what codes are covered, please contact Provider Services at: 1-866-690-5585.