As you’re likely aware, Harvard Pilgrim utilizes InterQual criteria and tools for medical review for select commercial prior authorization policies.
Using HPHConnect to request authorization for services through InterQual is a quick and efficient way to receive an authorization determination. We’ve put together an InterQual Medical Review Tip Sheet to make the process even easier for our valued provider partners.
The tip sheet, which you can find under “HPHConnect Resources” in the Electronic Tools and HPHConnect section of our provider website, offers guidance on:
- Steps to take before initiating a prior authorization
- Tips for accessing and printing SmartSheets (electronic authorization questionnaires)
- Conducting an InterQual review for a service
- Submitting a prior authorization request online
For any additional training needs you may have, feel free to contact us at Provider_Experience@harvardpilgrim.org.