Solution

InterQual® Ambulatory Care Planning Criteria

Evidence-based criteria for payers and providers who want to identify the appropriateness of ambulatory interventions.

Evidence-basedcriteria to support ambulatory care decisions

Ambulatory care planning criteria to assess appropriateness of interventions

Identify the appropriateness of ambulatory interventions with comprehensive criteria across ambulatory care. Best evidence-based recommendation is suggested within a single workflow according to the clinical scenario presented and appropriate sequencing of care alternatives, as well as screening for prior conservative treatments, which is specified where applicable.

Intuitive Q&A format to simplify review workflows

The intuitive Q&A format supports efficient review workflows across care categories and enables use by non-clinicians in payers’ provider portals. Includes regimen therapy, step therapy, and failed treatments within a single algorithm, as well as setting of care guidance and length of stay benchmarks. 

Evidenced based and peer reviewed for reliable guidance

Produced using a rigorous development process based on the principles of evidence-based medicine (EBM) to help ensure accuracy, avoid bias, and give you complete confidence in the underlying guidance the criteria provide. Limited evidence recommendations provide transparency for emerging areas of treatment and support the need for secondary review. 

What’s Included in InterQual® Ambulatory Care Planning Criteria

  • InterQual Ambulatory Care Planning Criteria

    • Specific and objective evidence-based criteria in Q&A format
    • Alternative and sequencing recommendations within a single workflow
    • Informational notes and extensive references
    • Limited-evidence recommendations to identify the need for a secondary review
    • Proprietary benchmarks for length of stay, where appropriate
    • InterQual Decision Reasons content add-on available with Procedures module
  • Available Modules

    • Durable Medical Equipment (DME)
    • Imaging
    • Molecular Diagnostics
    • Procedures
    • Specialty Referral
    • Specialty Rx Non-Oncology
    • Specialty Rx Oncology
    • Retrospective Monitoring

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