InterQual® Ambulatory Care Planning Criteria

Evidence-based criteria for providers and payers who want to support appropriate use of imaging studies, procedures, tests, equipment, and specialty medications and referrals.

Evidence-basedguidance to support appropriate medical resource utilization

Promote clinical quality

Support appropriate use by following clinical recommendations for DME, imaging, molecular diagnostics, procedures, specialty referrals, specialty Rx, and retrospective monitoring. 

Manage resource utilization

Support consistency by applying criteria prospectively or retrospectively to manage utilization and identify differences in practice patterns. 

Increase review efficiency

Streamline the review process with timely evidence-based guidance, extensive references, and an intuitive Q&A format presented within a single workflow, according to the clinical scenario. 

What's included

  • Ambulatory care planning criteria to support cost-effective medical resource allocation

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


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