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InterQual Criteria Rollout

Dear Provider,

We value everything you do to deliver quality care to our members - your patients - and ensuring they have a positive healthcare experience.

As part of the recent Wellcare acquisition, effective August 1, 2022, all markets currently utilizing Milliman Clinical Care Guidelines (MCG) will transition to InterQual for Medicare & Medicaid Inpatient Physical Health (Inpatient Admissions, Post-acute Care, Skilled Nursing Facility, Inpatient Rehabilitation, and Long-term Acute Care), Outpatient Physical Health, Inpatient Behavioral Health, and Outpatient Behavioral Health Services.

InterQual’s innovative software offers system-wide solutions that ensure appropriate and cost-effective care for your patients – our members.

For questions or information regarding our policies and procedures, visit our website at You can also contact your Provider Relations representative.

Thank you for all you do to provide quality care to our members.                



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Y0020_WCM_87476E Last Updated On: 11/17/2022