InterQual®

An evidence-based clinical decision support solution to help payers, providers, and government agencies make clinically appropriate medical utilization decisions.

InterQual Overview

InterQual aligns payers and providers with actionable, evidence-based clinical intelligence to support appropriate care and foster optimal utilization of resources. The foundation of the InterQual solution is our market-leading clinical Criteria, which helps payers and providers consistently apply evidence-based clinical decision support. Our Delivery options help reduce administrative cost by streamlining the medical review process. And our Optimization services ensure you get up and running quickly and efficiently and can use InterQual effectively. InterQual AutoReview and InterQual Connect build on this foundation with technology to automate the creation of the medical review and automate the prior authorization process, enabling exception-based UM.

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Criteria

InterQual Criteria are objective and specific to better help ensure the most appropriate care and more consistent, defensible decision-making. Our four criteria suites provide comprehensive coverage for medical and behavioral health across all levels of care as well as ambulatory care planning. With an outstanding track record, widespread adoption, and continual enhancement, InterQual Criteria are the standard for evidence-based clinical decision support. Learn about our evidence-based development process.

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InterQual® Level of Care Criteria

Assess the safest and most efficient care level based on severity of illness, comorbidities, complications, and the intensity of services being delivered.

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InterQual® Ambulatory Care Planning Criteria

Identify when imaging studies, procedures, DME, MDx tests, specialty pharmacy medications, and specialty referral consultations are appropriate.

Learn More about InterQual® Ambulatory Care Planning Criteria

InterQual® Behavioral Health Criteria

Manage the delivery of mental health and substance use care, including initial and concurrent level‐of‐care decisions.

Learn More about InterQual® Behavioral Health Criteria

Criteria Powered by InterQual® 

Content from the Centers for Medicare and Medicaid Services (CMS) and others is converted into our easy-to-use Q&A format to support consistent application of third-party content and improve review workflow and efficiency.

Learn More about Criteria Powered by InterQual® 

Customize InterQual® Criteria 

Incorporate custom content to more closely match your medical and business policies with the Customize tool.

Learn More about Customize InterQual® Criteria 
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Delivery

We provide a broad range of options to give you easy access to the InterQual Criteria and help streamline your medical review process.

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InterQual® Access Options

We offer a range of InterQual access options to meet any need, from desktop to mobile to cloud.

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InterQual® Interactive Medical Review Options

Our Interactive desktop and cloud applications provide access to the InterQual Criteria and help streamline the medical review process.

Learn More about InterQual® Interactive Medical Review Options
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Optimization

Our dedicated team of clinical, technical, and implementation experts is available to help you at every stage of product rollout and utilization. We provide implementation, education, and consulting services to help you make the most of the InterQual solutions you use, with options that fit your process, schedule, and budget.

Interrater Reliability

Measure how well, and how consistently, your staff applies InterQual Criteria with this web-based tool to help improve usage and quality within your organization.

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Education

Our education programs help meet your staff development needs with rigorous and effective training options, from introductory end-user training and physician education to advanced instructor certifications.

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Implementation

Benefit from expert knowledge and guidance at the very start. We provide a dedicated team of technical consultants, clinical consultants, and project managers to help you get started with our software solutions. Implementation services are provided for InterQual Review Manager and InterQual Connect.

Consulting

Our professional consulting services can help you obtain the greatest value from InterQual. Through analysis and direct observation, we can help you optimize product performance, improve business processes, identify strategic opportunities, and expand or develop new medical management programs and capabilities.

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