Effective May 1, 2021, UnitedHealthcare Community Plan of Arizona will be transitioning our evidence-based clinical care guidelines:
From MCG to InterQual for the evidence-based clinical care guidelines that support utilization management for physical health services
From MCG to Level of Care Utilization System (LOCUS), Child and Adolescent Level of Care/Service Intensity Utilization System CALOCUS-CASII) and Early Childhood Service Intensity Instrument (ECSII) – while continuing to use American Society of Addition Medicine (ASAM) – for the evidenced-based clinical care guidelines that support utilization management for behavioral health services
We expect that using these guidelines will further streamline our current clinical review processes while helping to reduce clinical decision turnaround times.
What is InterQual?
InterQual Care Guidelines are nationally recognized, evidence-based clinical criteria that we’ll use for prior authorization and inpatient management for all UnitedHealthcare health plans, including Medicaid, Medicare Advantage and commercial benefit plans.
What is LOCUS, CALOCUS-CASII and ECSII (L/C/E)?
LOCUS is a standardized level-of-care assessment tool developed by the American Association of Community Psychiatrists. LOCUS is used to make medical necessity determinations and placement decisions for adults.
CALOCUS-CASII is a standardized assessment tool developed by the American Academy of Child and Adolescent Psychiatry. CALOCUS-CASII is used to make medical necessity determinations and to provide level-of-service intensity for children and adolescents age 6 to 18.
ECSII is a standardized assessment tool developed by the American Academy of Child and Adolescent Psychiatry. ECSII is used to make medical necessity determinations and to provide level-of-service intensity for children from birth to age 5.
No disruption to your processes
These changes are happening within our internal technology structure. This should be seamless to care providers using our online portals and other systems. Your processes shouldn’t be affected and your daily work shouldn’t be disrupted.
Please contact your UnitedHealthcare representative or call the number on the member’s ID card.