CommercialPrior AuthMedium impact
2026 InterQual Criteria Implementation
Blue Cross Blue Shield of North Dakota·ND·Prior Authorization
Effective date
Aug 1, 2026
We identified it
Jun 23, 2026
Summary
Blue Cross Blue Shield of North Dakota is implementing updated 2026 InterQual criteria for prior authorization reviews effective August 1, 2026. The update includes specific organizational exceptions for episode day criteria, residential treatment centers, substance use treatment, and urgent home health evaluations.
Action Required
Before August 1, 2026: Billing and clinical teams must review the updated 2026 InterQual criteria sets via the Availity Essentials portal under Authorizations & Referrals section. Update prior authorization workflows to account for new organizational exceptions, including extended clinical documentation timeframes for RTC, LTAC, SNF, and acute rehab admissions (up to 3 days prior to admission). Train staff on new substance use residential treatment and urgent home health evaluation criteria exceptions.