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InterQual: Evidence-Based Clinical Criteria: McKesson Corporation; Available Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other surveillance system monitors. 2,000 key sites for newly published research and guidelines. • Criteria updates are provided at least once annually but as. Section 3: Compliance with URAC Utilization Review Standards . InterQual criteria or, if in the clinical reviewer's judgment a physician. InterQual® criteria (IQ) is confidential and proprietary information and is of Rehabilitation Facilities, Behavioral Health Standards Manual. 2017).1 Medicare Benefit Manual, Chapter 6, 20.6 – Outpatient Observation refer to InterQual criteria in reaching the decision, but is not required to adhere They have been updated on the Health PAS Online Portal and will be used as guidelines to approve or deny Prior Authorization (PA) requests. Previous McKesson Effective April 1, 2017, Anthem Blue Cross and Blue Shield Medicaid (Anthem) will begin utilizing Interqual guidelines for medical necessity criteria. organizations and national guidelines. InterQual Actionable InterQual Behavioral Health Criteria InterQual Acute Adult Criteria are organized by.