MedicaidAdministrativeMedium impact
Utilization Review – InterQual Behavioral Health Criteria
Illinois Medicaid - HFS·IL · Psychiatry·Provider Notice
Effective date
Dec 1, 2006
We identified it
Jun 21, 2026
Summary
Effective December 1, 2006, HSI will use InterQual Behavioral Health Criteria for reviewing inpatient behavioral health services under Medicaid. This standardizes the review process and may affect how behavioral health hospitalizations are approved and reimbursed.
Action Required
By December 1, 2006: Behavioral health providers should familiarize staff with InterQual Behavioral Health Criteria to ensure proper documentation for utilization review. Update documentation processes to include clinical indicators that meet InterQual standards for medical necessity determinations.