Post-Acute Care Guidelines

Prior authorization for post‑acute and home health care is granted only for services that meet McKesson InterQual® criteria (and, for Medicare members, the Medicare Benefit Policy Manual); the guideline does not list specific excluded diagnoses, frequency limits, age restrictions, or a detailed document checklist. Key requirement: clinical documentation must demonstrate that InterQual and, where applicable, Medicare Benefit Policy Manual criteria are met (other evidence‑based tools may inform home health decisions).

"Post-Acute Care Prior Authorization Criteria includes, but not limited to: McKesson InterQual® Criteria; Medicare Benefit Policy Manuals (Medicare members only)."

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