InterQual®
An evidence-based clinical decision support solution to help payers, providers, and government agencies make clinically appropriate medical utilization decisions.
What Is InterQual?
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.
InterQual 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.
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.
InterQual® Ambulatory Care Planning Criteria
Identify when imaging studies, procedures, DME, MDx tests, specialty pharmacy medications, and specialty referral consultations are appropriate.
