Update to 2016 McKesson InterQual Criteria Sheets: Bone Growth Stimulators
Effective January 17, 2017, the 2016 McKesson InterQual Criteria Sheets for Bone Growth Stimulators have been updated on the Health PAS Online Portal and will be used as guidelines to approve or deny Prior Authorization (PA) requests. If the nurse reviewer needs additional information to decide the request based upon the new criteria sheet, the PA request will be deferred for more info.
Old McKesson InterQual Criteria Sheets
On or after February 17, 2017, you must submit the appropriate 2016 McKesson InterQual Bone Growth Stimulator Criteria Sheet along with your PA request. If you submit the old version of the McKesson InterQual criteria sheet, your PA request will be deferred and you will receive a letter requesting the 2016 version.
Accessing the 2016 McKesson InterQual Criteria Sheets
The 2016 McKesson InterQual Criteria Sheets can be accessed by logging into your Trading Partner Account on the Health PAS Online Portal and following this pathway: Prior Authorizations > Manual, Forms and Criteria Sheets > Prior Authorization Document Library. You may also call Provider Services at 1-866-690-5585 to request a criteria sheet.
A Few Reminders
- Please go to the Health PAS Online Portal to access the McKesson InterQual Criteria Sheets, the MaineCare Criteria Sheets, and the MaineCare Supplemental Criteria Sheets to ensure you are accessing the most current version.
- Some McKesson InterQual Criteria Sheets and MaineCare Supplemental Criteria Sheets are meant to be reviewed as a "combo" criteria set. MaineCare policy and criteria shall supersede McKesson InterQual criteria. For example, this is applicable if deciding when it is appropriate to replace a durable medical equipment item or when a second opinion is required.
- The provider submitting the PA does not need to include the full criteria sheet in the submission to MaineCare. Instead, the provider may 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 pages for the scenario that applies.
- There may be procedure codes listed on the McKesson InterQual Criteria Sheets that are not covered by MaineCare. To be covered, a procedure code must be open and active in MIHMS.
- Please submit a completed Prior Authorization Request form along 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 which codes are covered, please contact Provider Services at: 1-866-690-5585.