Sunshine Health is now using 2023 InterQual Criteria

Date: 09/12/23

Fort Lauderdale, Florida

Sunshine Health now uses 2023 InterQual^® Criteria for all authorization requests.

InterQual is a nationally recognized evidence-based decision making tool for medical providers. When Sunshine Health does not have a clinical policy for medical technologies, procedures or pharmaceutical treatments, it will utilize InterQual criteria.

Sunshine Health started using the latest version of InterQual in May 2023. Providers may access the InterQual SmartSheet(s)™ for adult and pediatric procedures, durable medical equipment and imaging procedures by logging into the Secure Provider Portal or by calling Sunshine Health Provider Services at 1-844-477-8313.

Learn more about the 2023 InterQual Criteria.

In addition, Sunshine Health may delegate utilization management of specific services. In those cases, the delegated vendor’s guidelines may also be used to support medical necessity and other coverage determinations. Other non-clinical policies (such as payment policies) or contract terms may further determine whether a technology, procedure or treatment that is not addressed in Clinical Policy Manuals or InterQual® criteria is payable by Sunshine Health.

Questions?

If you have questions, please contact your Provider Engagement Administrator by selecting the county of your organization’s main office. You can also call Sunshine Health Provider Services at 1-844-477-8313 or visit the Secure Provider Portal. Stay up to date on Sunshine Health provider notices by reviewing and bookmarking Provider News.

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