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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

January 2020

InterQual Criteria for Cryotherapy for Prostate Cancer


Beginning on Feb. 28, 2020, Harvard Pilgrim will be utilizing InterQual® criteria and tools for our existing commercial cryotherapy for prostate cancer prior authorization policy, including an electronic authorization questionnaire that offers a quick and efficient way for you or your office staff to request authorization via HPHConnect.

While we encourage providers and office staff to request authorization electronically, Harvard Pilgrim will continue to accept authorization requests for cryotherapy for prostate cancer via phone (800-708-4414) or fax (800-232-0816). The InterQual Smartsheet will replace the existing Cryotherapy for Prostate Cancer Prior Authorization Request Form. If you don’t currently use HPHConnect to request authorization, the following resources can help you get started:

To request additional training, contact us at Provider_Experience@harvardpilgrim.org.

For more information on the medical review criteria, please refer to the Cryotherapy for Prostate Cancer Medical Review Criteria. You may view and print the complete medical necessity criteria and SmartSheet questionnaire via HPHConnect (go to www.harvardpilgrim.org/providerportal, select Resource Center and then the Upcoming InterQual link).

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