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.
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.
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.
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.
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.
The ASAM Criteria is a registered trademark of the American Society of Addiction Medicine