InterQual® Behavioral Health Criteria
Evidence-based clinical decision support for payers and providers who want to make the most appropriate care decisions for mental health and substance use.
Evidence-basedcriteria to support behavioral health decisions
Continuum and Q&A formats to provide timeline guidance
Help move patients safely and efficiently through the continuum of care by presenting all settings of care in one view, which incorporates the episode day/week for level-of-care decisions. Intuitive Q&A format simplifies appropriateness decisions for behavioral health services.
Comprehensive content to consider the whole patient
Determine the appropriate level of care or service by factoring in symptoms, comorbidities, functional status, SDoH risk factors, support-system quality, and more. The solution recommends lower levels of care when the patient is improving and more intense settings when the patient’s condition is deteriorating.
Development process to support mental health parity
Help address mental health parity by using InterQual criteria that are developed using the same evidence-based rigor we apply to—and are not more stringent than—our medical/surgical criteria.
Industry content structured for UM to drive consistent, efficient reviews
Streamline your medical review process by giving users easy access to The ASAM Criteria® and Medicare policies that have been converted into a structured, interactive tool.
What’s included in InterQual Criteria for Behavioral Health
Evidence-based behavioral health criteria
- InterQual criteria developed using evidence-based rigor and peer review standards
- Proprietary benchmarks for Length of Stay and Percent Paid as Observation
- Care management information notes with InterQual guidelines for expected progress, care facilitation, and admission considerations
- CMS crosswalk reference
- Four available modules cover 14 levels of care plus services
- Industry standard-of-care and regulated-use content seamlessly integrated into your workflow
- Content converted into our structured Q&A format to streamline medical reviews
- Two available behavioral health modules
- InterQual Adult and Geriatric Psychiatry
- InterQual Child and Adolescent Psychiatry
- InterQual Substance Use Disorder
- InterQual Behavioral Health Services
- The ASAM Criteria® Navigator (exclusive access)
- Medicare Behavioral Health Powered by InterQual
The ASAM Criteria is a registered trademark of the American Society of Addiction Medicine
- InterQual® Level of Care Criteria Assess the safest and most efficient care level based on severity of illness, comorbidities, complications, and the intensity of services being delivered. Learn more
- InterQual® Optimization Solutions Clinical education, interrater reliability, and solutions for InterQual optimization clients who want to get the most from their InterQual solution. Learn more
- InterQual® Technology Explore our interactive desktop, mobile, and cloud options for accessing InterQual® Technology and streamlining the medical review process. Learn more
- InterQual® Ambulatory Care Planning Criteria Use evidence-based criteria to identify when imaging studies, procedures, DME, MDs texts, specialty pharmacy medications, and specialty referral consultations are appropriate. Learn more