Solution

InterQual® Level of Care Criteria

Evidence-based clinical decision support for payers and providers who want to assess safe and efficient level of care based on illness severity, comorbidities, and complications.

Evidence-basedcriteria to support level of care decisions

Acute Care criteria to assess appropriate care level

Support effective, efficient care management by using criteria that are condition-focused and consider a holistic view of the patient to facilitate movement through the acute care continuum and decrease inappropriate admissions, avoidable days, and readmissions.

Spanning the full continuum of care to cover post-acute needs

Properly level the patient to the next least intensive setting by assessing clinical appropriateness for post-acute inpatient and outpatient services. The criteria help you ensure that there is timely movement of the patient along the care continuum, support functional recovery, and mitigate the risk of readmission.

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.

What’s Included in InterQual® Level of Care Criteria

  • InterQual Acute Care Criteria

    • Specific and objective evidence-based criteria for admission and level of care
    • Directs to observation status for select conditions
    • Integrates comorbidities and Social Determinants of Health (SDoH)
    • Care Management Information notes for expected progress, care facilitation, and readmission considerations
    • Proprietary benchmarks for Length of Stay and Percent Paid as Observation
    • Responder criteria, transition planning tools and readmission risk prompts
  • InterQual Post-Acute Care Criteria

    • Specific and objective evidence-based criteria for level of care, visit recommendations, and maintenance therapy
    • Visit recommendations
    • Integrates Medicare requirements, comorbidities and SDoH  
    • Care Management Information notes for expected progress, care facilitation, and readmission considerations
    • Proprietary benchmarks for Length of Stay
    • Responder criteria and transition planning tools
  • Available Modules

    • Acute Adult
    • Acute Pediatric
    • Long-term Acute Care
    • Inpatient Rehabilitation
    • Sub-acute and Skilled Nursing
    • Home Care
    • Outpatient Rehabilitation and Chiropractic

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PRODUCT SUPPORT

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