Solution
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.
What’s included in InterQual Criteria for Behavioral Health
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.
Our outcomes
- 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