DVHA staff utilizes clinical criteria for making Utilization Review (UR) decisions that are objective and based on sound medical evidence. Adopted criteria include the following:
- Change HealthCare InterQual® Guidelines;
- DVHA Clinical Guidelines; and
- Vermont State Medicaid Rules.
Change Healthcare InterQual® Guidelines are available to providers on the Vermont Medicaid secure provider web portal. After log-in, look for the link Change Healthcare Smart Sheets on the left window. InterQual® Guidelines are updated annually.
Visit the Vermont Medicaid Fee Schedule for the codes that require prior authorization. Excess quantity may require prior authorization.