Solution

InterQual® Connect

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

 

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Flexibleintegration to simplify the prior authorization process

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Reduce your administrative burden

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

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Increase payer and provider collaboration

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

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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.

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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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Our outcomes

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On-demand Webinar

Payer-Provider Ecosystems with InterQual® Connect

On-demand Webinar

Payer-Provider Ecosystems with InterQual® Connect

Explore how InterQual® Connect improves transparency and efficiency while providing a fast, direct, and secure payer/provider connection.

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White Paper

The ‘Intelligent’ 278: Creating a Standard for Shared Decision Support

White Paper

The ‘Intelligent’ 278: Creating a Standard for Shared Decision Support

Learn how modifying the HIPAA Healthcare Service Review X12-278 transaction standard could create a new tool to automate prior authorizations.

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Video

InterQual Connect™ Explained

Video

InterQual Connect™ Explained

Watch this two-minute video that explains how InterQual Connect can help automate the prior authorization process and transform utilization management.

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