MCG to InterQual Behavioral Health Transition

Effective September 1, 2022, Empire will transition from MCG Behavioral Health criteria to InterQual® Behavioral Health criteria.

 

Effective with dates of service on and after September 1, 2022, Empire will begin using InterQual® behavioral Health criteria for the review of behavioral health services for Fully Insured members only.  This represents a change from the behavioral health medical policies and clinical guidelines currently used. 

 

Please note that the following behavioral health (BEH) medical policies and clinical guidelines will be retained at this time:

• CG-BEH-02 Adaptive Behavioral Treatment for Autism Spectrum Disorder
• CG-BEH-14 Intensive In-Home Behavioral Health Services
• CG-BEH-15 Activity Therapy for Autism Spectrum Disorders and Rett Syndrome

 

Empire may continue to use additional medical policies and clinical guidelines to supplement InterQual® Behavioral Health criteria Guidelines.

 

This impacts Empire’s Commercial fully Insured health plans.

 

NYBCBS-COMM-000057-22