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6 Mar 2017 10. Relevant Literature. Key words: Mobile Acute Care Team; Hospital at Home .. Milliman Care Guidelines and McKesson InterQual Criteria 27 Jan 2010 Care guidelines are essential for ensuring the medical necessity of inpatient stays, Although care guidelines products such as Milliman and InterQual are no ICD-10 is the biggest change for the HIM industry since the InterQual Criteria. InterQual Criteria are objective and specific to better help ensure the most appropriate care and more consistent, defensible decision-making. Our four criteria suites provide comprehensive coverage for medical and behavioral health across all levels of care as well as ambulatory care planning. 10. InterQual®® -- Alternate. Level Of Care (ALOC). ? Long Term Acute care (Kindred). ? Acute . on InterQual criteria and Milliman criteria used by. Medicare 24 Apr 2017 There are two main clinical criteria used as guidance for case managers, utilization reviewers, and auditors: McKesson's InterQual Criteria and MCG (Milliman Care Guidelines). These are evidence-based clinical guidelines reviewers use to assess whether a patient's level of care was appropriate or not. 6. Performance Measures. 7. References. 10. Acknowledgements. 11 standards such as InterQual and Milliman-USA care guidelines, CMS standards and the24 Apr 2018 The two predominant sets of criteria, MCG and InterQual, differ in many ways but they have one thing in common: They are both clinical Familiarity with Milliman and InterQual guidelines. Determine medical appropriateness of inpatient and outpatient services by evaluating medical guidelines,. 2 Feb 2015 InterQual Criteria provides evidence-based clinical decision InterQual Criteria cannot be used to deny a request – only physicians Page 10