Last week, Dr. Lisa M. Scarfo, MD—Pediatrician and Medical Director at AllWays Health Partners, talked with us about bridging the gap between doctors and health insurance providers regarding the medical necessity process. She continues the conversation with how medical necessity can speed up prior authorization determinations. If you missed the first part, click here.
Otherwise, you can read part 2 of the two-part series below to learn about common misconceptions and some tips providers can benefit from and start using today.
InterQual increases consistency in the decision-making process
In addition to medical policies developed at the plan, AllWays Health Partners also utilizes InterQual criteria to determine medical necessity for many procedures and services. Interqual is a nationally recognized support solution grounded in clinical evidence and standards of care that help providers make clinically appropriate medical utilization decisions. InterQual has enabled us to make decisions based on the most up-to-date evidence. Since several insurance companies in the state use InterQual, this can simplify prior authorizations for providers. For providers who regularly perform the same procedures, we invite you to log onto our provider portal to review the InterQual criteria. This will help you learn exactly what clinical information is needed to meet the medical necessity criteria for your top service requests. AllWays Health Partners has also recently piloted InterQual Connect: an automated self-service tool available for some service requests. InterQual Connect allows provider staff to review criteria and select based on their clinical information to provide an authorization decision within seconds.
If you'd like to comment on our process and the criteria we use, AllWays Health Partners welcomes provider input. If you're interested in sharing your feedback, sign up for our Provider Roundtable here: