MedicaidAdministrativeMedium impact
[New York] 2026 InterQual updates
Anthem BCBS·NY · Psychiatry, Neurology, Pediatrics·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jun 1, 2026
Summary
Effective July 1, 2026, Anthem will transition to InterQual® 2026 criteria for psychological testing, neuropsychological testing, and developmental testing in New York. Billing teams must update clinical criteria references and prior authorization processes to align with the new 2026 InterQual guidelines.
Action Required
By June 30, 2026: Billing and clinical teams must obtain and review the InterQual® 2026 criteria documentation from Anthem. Update all prior authorization submission guidelines and internal clinical review processes to reference 2026 InterQual criteria instead of prior versions. Ensure staff submitting authorization requests for psychological, neuropsychological, and developmental testing cases use updated criteria. Contact Anthem Provider Services at 800-450-8753 with questions about specific criterion changes. Failure to align with new criteria may result in authorization denials or claim rejections.