Industry Content 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.

Support Consistent Application of Third-Party Content to Improve Review Workflow and Efficiency

Content from third-party sources is converted into our easy-to-use Q&A format. Policies that exist in disparate sources or are cumbersome to navigate are streamlined and structured using InterQual’s clinical rules and criteria development expertise.

Content powered by InterQual can be incorporated seamlessly into your existing InterQual workflow to create a structured, interactive tool that can help reduce review times, support review consistency, and streamline the prior authorization process. Providing a single source for content helps minimize the need to use and update multiple systems and supports the consistent and efficient application of medical policies.

Industry Content by InterQual are available for:

Medicare Policies

InterQual provides comprehensive content fully aligned with Medicare NCD/LCDs (National and Local Coverage Determinations) and policy articles within your InterQual workflow. This criteria provide medical necessity support, quantity and time-frame utilization limits and non-covered indications and services for:

  • Medicare Procedures
  • Medicare Durable Medical Equipment
  • Medicare Molecular Diagnostics and Lab
  • Medicare Imaging
  • Medicare Pharmacy
  • Medicare Behavioral Health

Third Party Content

InterQual works with a variety of organizations to convert their proprietary content into our structured, actionable format.

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