October 2, 2025

As a reminder, Jefferson Health Plans/Health Partners Plans uses Change Healthcare’s InterQual® criteria as a guideline for making medical necessity determinations. Effective November 3, 2025, we will implement the 2025 InterQual criteria for the modules below:

• LOC: Acute Adult
• LOC: Acute Pediatric
• LOC: Long Term Acute Care
• LOC: Inpatient Rehabilitation
• LOC: Subacute/SNF
• LOC: Home Care Q&A
• CP: Procedures
• CP: Durable Medical Equipment
• Medicare Post Acute & Durable Medical Equipment
• Medicare Procedures

For any inquiries, please contact our Provider Services Helpline at 1-888-991-9023, available Monday through Friday from 9:00 a.m. to 4:30 p.m.