Important update: InterQual Connect Prior Authorizations
Mar. 2022Important Notices
"As a reminder, prior authorizations for imaging and cardio procedures previously managed by Health Help will resume formal clinical reviews effective March 1, 2022. At this time there is no change to MSK/Orthopedic reviews.
Please ensure that prior authorization requests are submitted with complete information to increase the likelihood that they will be auto approved, eliminating the need for manual review and delayed authorizations."
Please ensure that prior authorization requests are submitted with complete information to increase the likelihood that they will be auto approved, eliminating the need for manual review and delayed authorizations."
Recent Announcements
Clinical documentation required for hip, knee, and shoulder prior authorizations
As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for hip, knee, and shoulder procedures in accordance with its established policies and procedures, in addition to CMS requirements that medical record documentation must support the medical necessity of the services requested.Jul. 2025Important Notices
Clinical documentation required for hip, knee, and shoulder prior authorizations
As you know, UPMC Health Plan requires certain clinical documentation/notes in support of a request for prior authorization for hip, knee, and shoulder procedures in accordance with its established policies and procedures, in addition to CMS requirements that medical record documentation must support the medical necessity of the services requested.Jul. 2025Important Notices
Understanding MP.PA.147
Understanding changes to the Diagnostic and Surveillance Colonoscopy, 18 Years Old and Older – MP.PA.147 policyJul. 2025Important Notices