Solution

InterQual® Connect

An integrated medical review and connectivity solution for payers and providers who want to automate prior authorizations within their existing workflows.

 

Flexibleintegration to simplify the prior authorization process

Reduce your administrative burden

Streamline the medical review process by integrating automated prior authorizations into your existing workflows and eliminating redundant medical reviews.

Increase payer and provider collaboration

Remove costly interoperability barriers by enabling faster authorization approvals and providing transparency into medical review and authorization criteria.

Reduce your IT burden

Speed deployment and conserve your IT resources by implementing an integrated solution with alliance partners  that doesn’t require new hardware or software.

Support medical necessity

Conduct efficient medical reviews by using InterQual® Criteria within your existing UM/CM system workflow or a payer’s provider portal.  

What's included

  • Medical review service

    • Conduct medical reviews through a user-friendly interface with cloud-based access to InterQual Criteria
    • Access the Medical Review Service within your existing UM/CM system or via your payer’s provider portal
    • Support transparency by enabling payers to publish their unique policies for provider review  
  • Authorization connectivity

    • Transmit an authorization request (and InterQual medical review) directly to payers across our authorization gateway
    • Receive an automated determination status back after the payer has reviewed and applied business rules
    • Enable payers to practice exception-based processing for requests that cannot be automatically approved
    • Eliminate duplicative medical reviews and save staff time on routine authorizations
    • Connect payers and providers via a secure, proven authorization gateway that supports thousands of authorization transactions per week 
  • Integration partners

    • Payers can automate authorizations by integrating InterQual Connect into their internal UM solutions and provider portals 
    • Providers can streamline the medical review and prior-authorization process by integrating InterQual Connect into their care management workflows 

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