Software

InterQual® AutoReview

An automation solution for providers who want to leverage clinical data from their EHR to automatically complete accurate, defensible InterQual medical reviews.

 

Transformutilization management with automated medical reviews

Reduce your administrative burden

Streamline operations  by receiving automated medical reviews within your utilization management/case management (UM/CM) system workflow. 

Help improve clinical outcomes

Allow utilization review nurses to focus on the cases that require their expertise by eliminating up to 75% of the time it takes to conduct manual reviews.

Increase payer/provider trust

Promote transparency and help reduce potential denials by using automated medical reviews that eliminate data-entry errors by extracting clinical values from your EHR.

Make better clinical decisions

Support accurate level of care determinations by matching clinical data to discrete InterQual criteria points for defensible medical necessity decisions. 

What's included

  • Integrate medical reviews into your UM/CM workflow

    • Benefit from a fast, easy implementation with this flexible SaaS solution
    • Validate completed reviews and make any necessary edits from within your existing workflow
    • Prioritize case management activities and focus on the exceptions that require expertise
  • Automate medical reviews with data from your EHR

    • Extracts the necessary data from your EHR to conduct automated reviews
    • Map clinical data to codified InterQual® criteria to create InterQual® Episode Day 1 Review
    • Increase payer/provider trust by embedding the clinical values used to satisfy each criterion
    • Transmit auto-generated  reviews directly to payers for increased efficiency and greater transparency 
  • Support appropriate care decisions with evidence-based criteria

    • Leverage specially codified InterQual® Criteria adapted to support the automated process
    • Determine the appropriate level of care for patients admitted through the ED using codified InterQual® Acute Adult Criteria 
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