Software

InterQual®

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

 

Evidence-basedclinical intelligence to support appropriate care

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Support medical necessity decisions

Assess the safest, most efficient care level by using objective, specific criteria based on severity of illness, comorbidities, complications, and the intensity of services delivered.

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Promote clinical quality

Help improve patient outcomes and medical resource utilization by identifying when imaging studies, procedures, DME, MDx tests, specialty medications, and specialty referrals are appropriate.

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Support behavioral health decisions

Support appropriate care by managing your delivery of mental health and substance use care, including initial and concurrent level‐of‐care decisions. 

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Improve review workflow and efficiency

Help improve review times and support consistency by integrating third-party content from CMS and other sources into your InterQual workflow.

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Provide access to InterQual criteria

Improve usability and transparency by providing multiple InterQual access options to meet any need, from desktop to mobile to cloud.

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