CommercialCoverageMedium impact
Level of Care Criteria for Inpatient, Residential, Partial Hospital, and Intensive Outpatient Mental Health Services for Adults and Children 3.01.21
Excellus BlueCross BlueShield·NY · Psychiatry·Behavioral Health (Psychiatry/Psychology)
Effective date
Apr 16, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated level of care criteria for behavioral health services in New York State, effective April 16, 2026. The policy establishes specific medical necessity criteria using InterQual standards for inpatient, residential, partial hospital, and intensive outpatient mental health services for adults and children, with additional state-specific criteria when InterQual standards aren't met.
Action Required
Before April 16, 2026: Behavioral health providers must ensure documentation meets the new InterQual Behavioral Health criteria and additional New York State-specific requirements for level of care determinations. Update clinical documentation templates to include risk of harm, functional status, and co-morbidity assessments. Review utilization management processes to align with the new criteria for episodes beyond initial authorization periods.