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Level of Care and Treatment Criteria

Effective April 24, 2006, MHN fully implemented the use of InterQual criteria for case review. InterQual can lead to improved consistency in decision making by evaluating patient-specific behaviors and symptoms to help make clinically appropriate decisions. This can empower our care managers to apply objective, evidence based criteria to support their level of care and continued stay decisions. Supporting appropriate care decisions can lead to better outcomes for our members. InterQual criteria are nationally recognized evidence based treatment guidelines produced by the McKesson Company.

All authorization decisions are reviewed using the InterQual criteria, however, in addition to meeting those criteria, MHN also reviews the plan of treatment for appropriateness and timeliness. Guidelines for elements considered in the treatment plan review, as well as the MHN clinical practice guidelines.

It is MHN's policy to share specific level of care guidelines in writing with contracted providers, members, customers and members of the general public who request them. Copies of criteria can be obtained by calling MHN:

For Providers:

Contact Professional Relations Department at Professional.Relations@mhn.com

For Members:

Call the specific number listed on your card