June 26, 2012




All Blue Cross Contracting Hospitals


Connie Winkley – Education/Communication Coordinator
Institutional Provider Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association


BCBSKS Precertification System to be updated with 2012 InterQual®

McKesson has released their 2012 update of its InterQual clinical criteria and software that helps providers and payers determine the appropriate use of their resources and improve the quality of care. Enhancements this year include the addition of a “condition-specific” model to the InterQual Acute Care set and a progression to further efficiencies and effectiveness of care management method.

This new InterQual release creates an even more proactive, insightful and mutual review process that will help ensure clinically appropriate admissions and manage lengths of stay, while lowering administrative costs. All InterQual Acute Criteria now utilize a “condition-specific” approach, which categorizes the criteria by primary condition and then incorporates additional information intended to address relevant complications, co-morbidities and guideline typical treatments. This condition-oriented model presents criteria for all levels of care in one workflow, combines intensity and severity criteria for admission and continued stay review and combines distinctive “response to treatment” evaluations.

BCBSKS will be upgrading their precertification system with the 2012 InterQual clinical criteria and software in July 2012. An update on the specific implementation date and additional instruction and materials on the use of the 2012 InterQual version will be forthcoming in the next few weeks and will be sent through our email notification system.

Current precertification processes that will not change include:

Please share this information with any other members of your provider staff that will be affected by this upcoming change to the electronic BCBSKS precertification system. Encourage your staff to sign-up with our eNews to receive future updates regarding precertification that will include valuable information and instructions on the use of InterQual 2012.

If you have any questions regarding this notification, please contact your BCBSKS Provider Representative.