Solution Bundle

InterQual® Solution

An evidence-based clinical decision support solution for payers, providers, and government agencies who want to help ensure clinically appropriate medical-utilization decisions


What’s included in InterQual

  • Evidence-based criteria

    • InterQual criteria developed using evidence-based rigor and peer-review standards
    • Proprietary benchmarks for Length of Stay and Percent Paid as Observation
    • Care-management information notes with InterQual guidelines for expected progress, care facilitation, and admission considerations
    • CMS crosswalk reference
    • Three criteria suites: Level of Care, Ambulatory Care Planning, Behavioral Health 
  • Industry Content

    • Industry standard-of-care and regulated-use content seamlessly integrated into your workflow
    • Content converted into our structured Q&A format that streamlines medical reviews
    • A suite of Medicare policies, as well as The ASAM Criteria and Concert Genetics coverage criteria
  • Technology Solutions

    • Interactive review options: InterQual Medical Review Service, InterQual Anonymous Review
    • Access options: InterQual Online, InterQual View, InterQual Mobile
    • InterQual Transparency 
  • Optimization Options

    • InterQual Education services, including Learning Basics, InterQual Certified Instructor, and more
    • InterQual Interrater Reliability online testing application
    • InterQual Customize content-creation and editing software

Evidence-basedcriteria and technology to support appropriate clinical decisions

Woman using computer

Evidence-based InterQual Criteria to support appropriate care decisions

Make the safest, most efficient care decisions by using objective, specific criteria for both medical and behavioral health across all levels of care, as well as ambulatory care planning. InterQual Criteria are produced using a rigorous development process based on the principles of evidence-based medicine (EBM) to give you complete confidence in the guidance provided.

3 Solutions

Related solutions

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    InterQual® Level of Care Criteria

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    InterQual® Ambulatory Care Planning Criteria

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    InterQual® Behavioral Health Criteria

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Industry content structured for UM to drive consistent, efficient reviews

Streamline your medical review process by giving users easy access to industry content, such as The ASAM Criteria® and Medicare policies, that have been converted into a structured, interactive tool.

1 Solution

Related solutions

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Technology solutions to enable InterQual Criteria use

Get easy access to the InterQual Criteria, streamline your medical review process, and provide transparency with the access options that best meet your needs. 

1 Solution

Related solutions

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Optimize your InterQual solutions

Make the most of the InterQual solutions you use with our education, IRR, and customization solutions. Rigorous and effective education options help meet your staff-development needs, and the Interrater Reliability web-based tool helps improve usage and quality within your organization.

Let’s start a conversation

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Our experts will:

  • Discuss your individual use case and business needs
  • Explain our features, benefits, and services
  • Show how this solution can help achieve your goals

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