Providers
Medical providers
Coverage policy and pre-certification/pre-authorization
Coverage policy and pre-certification/pre-authorization information for out-of-area members.
View coverage policyInterQual® 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.
Please consult your provider for applicable policies and/or criteria.
Providers' News
Find updates on the latest policies and procedures for providers.
Read Providers' NewsPersonal 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