InterQual® Behavioral Health Criteria

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

Support Behavioral Health Care Decisions in an Age of Parity

InterQual® Behavioral Health Criteria support initial and continued stay level-of-care decisions across the behavioral health continuum of care. The criteria address the varying needs of geriatric, adult, adolescent, and child patients with both psychiatric and substance use disorders. The depth of criteria allows care managers to consider symptoms, functional status, and quality of support systems as determinants for the most appropriate level of care. The criteria follow our continuum format and present all levels of care in one view. This format incorporates the episode-day feature to provide timeline guidance for each patient and condition (similar to the level-of-care condition-specific format). It also provides criteria to assess the status of the individuals’ symptoms and provides guidance for safe movement to alternate levels of care.

These capabilities empower care managers to make the most appropriate initial and ongoing level-of-care decisions based on each patient's individual presentation for:

  • Psychiatric conditions
  • Substance use
  • Dual diagnosis

Because the criteria encourage reviewers to consider the severity of symptoms or behaviors in the context of patient-specific variables, reviewers are equipped to place patients in the most appropriate level of care. Additionally, standardized decision paths provide case managers, utilization reviewers, and providers with a common language that enables consistent, objective decision-making.

Incorporating the expertise of a multidisciplinary panel of psychiatrists, psychologists, psychiatric nurses and social workers, InterQual Behavioral Health Criteria covers:

  • Adult & Geriatric Psychiatry
  • Child & Adolescent Psychiatry
  • Substance Use Disorders
  • Behavioral Health Services

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

InterQual® Evidence-Based Development

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 underlying guidance the criteria provide.