MedicaidPrior AuthHigh impact
InterQual 2026 Implementation Provider Notice: Effective 7/6/2026
Ambetter·LA·Prior Authorization
Effective date
Jul 6, 2026
We identified it
Aug 26, 2026
Summary
Louisiana Healthcare Connections will implement InterQual 2026 criteria effective July 6, 2026 for utilization management reviews across both physical and behavioral health services. This evidence-based decision support tool will be used to screen medical necessity for procedures, durable medical equipment, and imaging services. Providers must access updated InterQual SmartSheets through the secure provider portal to stay current with new criteria.
Action Required
By July 6, 2026: Billing team and clinical staff must (1) Access and review the updated InterQual 2026 SmartSheets for adult and pediatric procedures, durable medical equipment, and imaging services through the Louisiana Healthcare Connections secure provider portal; (2) Update prior authorization processes and decision trees to align with InterQual 2026 criteria; (3) Train billing staff on new medical necessity screening requirements to ensure claims comply with updated guidelines; (4) Update any internal authorization protocols and documentation checklists to reference InterQual 2026 standards. Contact Provider Services or your Provider Network Consultant with questions. Failure to implement updated criteria may result in claim denials for services that do not meet new medical necessity standards.