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If we want to request a reconsideration, can we use Interqual criteria as justification?

April 26, 2017criteria interqual justification Reconsideration request

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If we want to request a reconsideration, can we use Interqual criteria as justification?

1 Answer

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10 Posted

Any substantial information showing that Interqual criteria may have resulted in an approval may be sent to the physician reviewing the reconsideration. The physicians review will be based on his/her professional experience, knowledge and judgement.