Education & Training

IMPORTANT UPDATES

InterQual® Integration Coming to the Atrezzo Provider Portal September 1, 2026

Beginning September 1, 2026, providers will have the option to use integrated InterQual® (IQ) Criteria when submitting prior authorization requests through the Atrezzo Provider Portal for applicable service types.

This new, optional functionality is designed to help providers submit more complete authorization requests by providing additional guidance regarding the clinical information and documentation that may be needed to support medical necessity review. Providers may continue to submit prior authorization requests through the existing Atrezzo submission process without completing the integrated InterQual workflow.

InterQual will be available for most service types. Dental, Physician Administered Drugs (PAD), Traumatic Brain Injury (TBI), and Transportation are excluded from the integrated InterQual workflow. Depending on the service requested, medical necessity review will continue to follow Indiana Medicaid's established clinical review hierarchy and may be based on applicable Benefit Module or Indiana Administrative Code (IAC) requirements.

Please remember: Completion of the integrated InterQual workflow does not guarantee authorization approval or independently determine the final decision. All requests will continue to be reviewed according to applicable Indiana Medicaid requirements, coverage policies, and approved medical necessity criteria.

Get Ready

Training resources will be available on the Acentra Health Provider Training Website to help providers become familiar with the new functionality. Providers are encouraged to review available resources prior to implementation.

Additional information will also be communicated by Indiana Medicaid through an upcoming provider bulletin.

Questions?
Contact Acentra Health Customer Service at 1-866-725-9991 for assistance with prior authorization submissions or the Atrezzo Provider Portal.

Thank you for your continued partnership in serving Indiana Medicaid members.

Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Rule (CMS-0057-F)

Per Bulletin BT2025165 Effective Jan. 1, 2026, IHCP providers will have updated guidelines regarding PA decisions and additional information submissions. This applies to PA requests for items and services, excluding drugs, as defined in Code of Federal Regulations 42 CFR 421.60(b)(6). Pharmacy PA request decisions are still made within 24 hours of request, in accordance with 42 CFR 1396r-8(c)(5)(A).

Acentra Health will continue to be required to make a PA decision within 7 calendar days of the initial standard PA request. The time may be extended up to an additional 7 calendar days (previously 30 calendar days) if additional information is needed.

For an urgent/expedited PA request, a decision will be required within 72 hours. No pend (extension) time frame will be allowed for urgent/expedited FFS PA requests.