Beacon Adopts New Medical Necessity Criteria

Effective March 1, 2020, Beacon starts to use Change Healthcare's InterQual ® medical necessity criteria.

Using nationally recognized criteria is consistent with mental health parity requirements. Beacon is committed to strengthening and enhancing clinical quality by leveraging these best-in-class, evidence-based criteria.

  • Accounts that require the use of state-specific or other medical necessity criteria are not impacted.
  • Substance Use criteria are not impacted (ASAM/LOCADTR / other state criteria remain the same).
  • Other processes and workflows remain the same (such as the authorization process); only the criteria are changing.
  • Providers should not submit authorization requests through InterQual. The Beacon authorization process remains the same.

Want a learn how to use InterQual medical necessity criteria?

Sign up for training:

An overview of how to view and access Beacon’s Medical Necessity Criteria via InterQual for providers.

·         3/26/2020 1:00 PM CLICK HERE TO REGISTER

·         4/30/2020 1:00 PM CLICK HERE TO REGISTER

·         5/21/2020 1:00 PM CLICK HERE TO REGISTER

·         6/25/2020 1:00 PM CLICK HERE TO REGISTER