Clinical Decision Support (InterQual) Solutions

Clinical decision support solutions to help healthcare providers, payers, and government agencies make clinically appropriate medical utilization and care decisions.

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Accurate, Evidence-Based Criteria and Innovative Decision Support Solutions

Decision Support

For those devoted to appropriate care

No matter where or to whom healthcare is delivered, the priority for payers and providers is the same: to provide quality care efficiently.

The foundation of the Decision Support portfolio is our rigorously developed clinical criteria, InterQual®, which helps you consistently apply evidence-based clinical decision support to promote appropriate, medically necessary care.

Our technology innovations help reduce administrative costs by streamlining and automating medical reviews and authorizations while also bringing clarity to molecular diagnostics.


Always innovating

For four decades, the InterQual team has upheld the singular vision of improving patient outcomes by advocating and supporting evidence-based care. Our innovative clinical content, technologies, solutions, and services have helped reduce the administrative burden, enhance payer-provider relations, and improve quality care.

Our history of innovation is extensive: We were the first to bring you evidence-based clinical criteria; an automated workflow solution; molecular diagnostics test identification and policy management; automated authorization and integration of that authorization within existing workflows; and automation of the medical review using data from your EHR, to name just a few of our transformative tools.

And as healthcare continues to evolve, so will InterQual and the Decision Support family.

Delivering Exception-Based Utilization Management

Appropriate Quality Care
Improve outcomes and avoid denials

Now more than ever, providers and payers need defensible, consistent decision-making support and an efficient way to proactively manage patient care to reduce length of stay, inappropriate admissions and readmissions, unneeded interventions and, in turn, denials.

With rigorously developed, frequently updated and objective content, InterQual aligns providers and payers with actionable, evidence-based clinical intelligence.

7.8% Shorter hospital stays in InterQual hospitals

Reduced Administrative Costs
Automate routine tasks and focus on the exceptions

Reduce the administrative burden of manually conducting medical reviews and processing prior authorizations, provide/receive quicker authorization approvals, and achieve greater transparency, all within your existing workflows, with our innovative automation solutions, InterQual AutoReview and InterQual Connect.

Move to an exception-based utilization management process that allows you to focus your skilled staff on the exceptions that require their expertise while your systems automatically process the rest.

MDx Test Management
Reduce time and costs managing MDx test claims

Easily identify the precise test under review and reduce review time with the DEX Diagnostics Exchange, a test identification and policy management solution that connects payers and laboratories to drive appropriate molecular diagnostics coverage and reimbursement.

75% decrease in the time spent on MDx prior authorizations, (Fallon case study)

Our Clinical Decision Support Solutions