Skip to Content (Press Enter)


Medical providers

Coverage policy and pre-certification/pre-authorization

Coverage policy and pre-certification/pre-authorization information for out-of-area members.

View coverage policy

InterQual® Coverage Policy Guidelines

The InterQual® guidelines are used by our utilization management team to help assess whether a given medical condition and known or represented circumstances of a case support medical service(s) as the most appropriate treatment, or whether the medical condition/circumstances presented could be appropriately addressed with an alternative treatment. Use the self-registration tool at the link to create a login and view the criteria. Individuals without an email address should contact the plan to receive the criteria information via mail.

View guidelines

Providers' News

Find updates on the latest policies and procedures for providers.

Read Providers' News

Personal Health Record (PHR)

A confidential, electronic medical record with information available from medical claims and testing, combined with information provided by the patient.

View PHR