InterQual® and COVID-19

The InterQual 2020 release, issued on April 17, 2020, included criteria to manage COVID-19 patients. To support customers who do not already license these criteria or have not yet implemented the InterQual 2020 release, Change Healthcare has packaged InterQual criteria related to COVID-19 into a module that can be accessed through our InterQual Cloud Solutions. 

The InterQual® content development team has been closely monitoring the evolution of the COVID-19 virus, as well as the clinical practice recommendations and literature as they become available. The following information outlines how InterQual criteria addresses the COVID-19 patient population.

(For your convenience, this information will also be accessible as a document on the Customer Hub. To access it, select “Knowledge Items” on the left navigation pane and enter the key word “COVID-19”.) 


May 14, 2020

The InterQual COVID-19 criteria module is a compilation of InterQual 2020 criteria subsets and span the full continuum of care across the following InterQual Criteria modules:

  • Acute Adult and Pediatric
  • Long-Term Acute Care
  • Subacute/Skilled Nursing Facility
  • Home Care
  • Durable Medical Equipment
  • Medicare Durable Medical Equipment Powered by InterQual

All current InterQual Cloud Solutions customers will be granted access to this COVID-19 Criteria module automatically on the morning of Friday, May 15.

If your organization has configured your environment to disable new criteria releases by default, you will need to log in to the administration module and enable the criteria when you are ready to start using it.

If you are not a current InterQual Cloud Solutions customer, you can request access by registering at https://inspire.changehealthcare.com/InterQual-Covid-19.

As more information about the pandemic becomes available, additional subsets within the InterQual criteria modules outlined above may be added. When updates are made, you will continue to receive these Client Communications.


March 16, 2020

Frequently Asked Questions

Will all patients with COVID-19 require admission? 

Routine admission for all patients with COVID-19 has not been advocated. The severity of illness in patients with COVID-19 is highly variable. Some patients will have mild symptoms not requiring hospitalization, while others may experience severe illness requiring hospital-level services or interventions.

Disposition decisions should be individualized. Clinical presentation, the ability to engage in monitoring, and each patient’s home situation (including isolation and risk of transmission) should be considered in determining the appropriate venue of care. At this time, treatment consists of supportive care based on the patient’s symptomatology. 

How does InterQual criteria currently address COVID-19?

In 2019.1 Acute Adult and Pediatric Level of Care criteria, criteria application for the patient with COVID-19 is symptom-based. The reviewer should apply criteria based on the presenting symptom or required interventions (e.g., dyspnea, respiratory distress, dehydration, high flow oxygen, mechanical ventilation) driving the need for hospitalization. Criteria may be found in a variety of subsets including but not limited to: Infection: General, General Medical, and Dehydration or Gastroenteritis subsets.

How will InterQual criteria address COVID-19 in the 2020 release?

In 2020 Acute Adult and Pediatric Level of Care criteria, criteria application for the patient with COVID-19 will remain symptom-based. Criteria, notes, codes, and index/keywords have been updated/added within the Infection: General subset to streamline the review and make the criteria more intuitive and easier to find for the patient who presents with dyspnea or respiratory distress. Patients who present with additional symptoms driving the need for hospitalization should be reviewed using the appropriate subset based on their symptoms (e.g., dehydration, pneumonia). 

How frequently will COVID-19 criteria be updated?

Currently, the scale of the COVID-19 pandemic remains uncertain, and evidenced-based practice recommendations are evolving rapidly. The InterQual Clinical Content team will continue to evaluate evidence as it becomes available and will update criteria as necessary. Please refer to the Customer Hub for updates.