Updated Clinical Criteria - Effective August 15, 2025

Date: 07/15/25

This notice is to inform you that MHS Health Wisconsin has updated our clinical criteria. These changes apply to our Medicaid and Medicare (Wellcare By Allwell) lines of business.

The updated InterQual Medical Necessity Criteria set is effective August 15, 2025.

To learn more about InterQual clinical criteria, visit the Clinical and Payment Policies page on our website.

Thank you for being a valued partner in caring for the health and well-being of our members. If you have any questions about the information shared above, please contact your Provider Relations representative or call the Provider Inquiry Line at 1-800-222-9831. If you are unsure who is your representative, please email us at WI_Provider_Relations@mhswi.com.