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Provider Monthly: Interqual updates, editing system upgrade, and recognizing national recovery month in September 2021

Featured Story:

Meet Barry Shelton: peer recovery coach at AllWays Health Partners

Did you know that AllWays Health Partners was one of the first health plans in the country to have peer recovery coaches on staff? Seeing as September is National Recovery Month, we want to take this timely opportunity to share some of the life-changing work of our Peer Recovery Coaches and the impact that has on members' access to the different pathways of recovery. National Recovery Month

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To view last month's newsletter or any previous month, visit our Admin Newsletter Archive.

In this issue:

  • On-demand webcast by Optum
  • AllWays Health Partners’ Drug fee schedules to be updated
  • Claims editing system upgrade
  • InterQual 2021 Updates
  • Cardiac Imaging- change in PA status
  • COVID-19 specimen collection
  • Urgent authorization requests
  • Revised medical policies
  • Code updates
  • Formulary updates

On-demand webcast by Optum

Sign up now for Behavioral Health Identification, Treatment and Referral in Primary Care - A 3-Part On-demand Learning Series from Optum (earn up to 3 credits)


AllWays Health Partners’ Drug fee schedules to be updated

AllWays Health Partners reviews its drug fee schedules quarterly to ensure that they are current, comprehensive and consistent with industry standards, to the extent supported by its systems. In most cases, changes involve adding fees for new or existing codes, to supplement the fees already on the fee schedule.

The next update will occur on October 1, 2021. Changes may involve both new and existing CPT and HCPCS codes, and will include the planned quarterly update to physician administered drugs, immune globulin, vaccine and toxoid fees.

Claims editing system upgrade

We upgraded our claims editing system to better reflect the industry standards within the New England market. Effective August 16 we moved to ClaimsXten. This will improve claim accuracy and reduce appeals.  For more information, visit their website.


InterQual 2021 updates

InterQual imaging criteria, which includes High Tech Radiology and Cardiac Imaging, has been updated to the 2021 version. All other InterQual criteria will be updated to the 2021 version by October 1, 2021.

Cardiac Imaging- change in PA status

Effective immediately (9/1/2021), prior authorization is not required for the following CPT codes related to Cardiac Imaging:

  • 93303
  • 93306
  • 93320
  • 93321
  • 93325
  • 93307

Covid-19 specimen collection

Beginning September 16, 2021, Covid-19 specimen collection will be no longer be separately reimbursable for the MassHealth LOB. Specimen collection is included in the reimbursement of the Covid-19 lab test or Evaluation and Management Service. For more info, visit mass.gov


Urgent authorization requests

Reminder for providers: If you have an urgent authorization request you should page the on call nurse reviewer at 1-855-444-4647 after submitting the authorization and corresponding clinical information, otherwise there could be a delay in these urgent requests.  


Medical Policy Updates -September 1, 2021 Effective Date

5 medical policies were reviewed and passed by the AllWays Health Partners Medical Policy Committee. These policies are now posted to allwayshealthpartners.org

The table below is a summary of the policies and the changes:

For more information or to download our medical policies, go to allwayshealthpartners.org/providers/medical-policies and select the policy under the medical policy listings.


Code Updates

CPT Code Updates

Drug Code Updates

Topics: Providers




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