InterQual®

An evidence-based clinical decision support solution to help payers, providers, and government agencies make clinically appropriate medical utilization decisions.

What Is InterQual?

InterQual aligns payers and providers with actionable, evidence-based clinical intelligence to support appropriate care and foster optimal utilization of resources. The foundation of the InterQual solution is our market-leading clinical Criteria, which helps payers and providers consistently apply evidence-based clinical decision support. Our Delivery options help reduce administrative cost by streamlining the medical review process. And our Optimization services ensure you get up and running quickly and efficiently and can use InterQual effectively. InterQual AutoReview and InterQual Connect build on this foundation with technology to automate the creation of the medical review and automate the prior authorization process, enabling exception-based UM.

InterQual Criteria

InterQual Criteria are objective and specific to better help ensure the most appropriate care and more consistent, defensible decision-making. Our four criteria suites provide comprehensive coverage for medical and behavioral health across all levels of care as well as ambulatory care planning. With an outstanding track record, widespread adoption, and continual enhancement, InterQual Criteria are the standard for evidence-based clinical decision support. Learn about our evidence-based development process.

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.

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InterQual® Ambulatory Care Planning Criteria

Identify when imaging studies, procedures, DME, MDx tests, specialty pharmacy medications, and specialty referral consultations are appropriate.

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InterQual® Behavioral Health Criteria

Manage the delivery of mental health and substance use care, including initial and concurrent level‐of‐care decisions.

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Industry Content by InterQual® 

Content from the Centers for Medicare and Medicaid Services (CMS) and others is converted into our easy-to-use Q&A format to support consistent application of third-party content and improve review workflow and efficiency.

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Customize InterQual® Criteria 

Incorporate custom content to more closely match your medical and business policies with the Customize tool.

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InterQual Criteria Delivery

We provide a broad range of options to give you easy access to the InterQual Criteria and help streamline your medical review process.

InterQual® Access Options

We offer a range of InterQual access options to meet any need, from desktop to mobile to cloud.

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InterQual® Interactive Medical Review Options

Our Interactive desktop and cloud applications provide access to the InterQual Criteria and help streamline the medical review process.

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InterQual Optimization

Our dedicated team of clinical, technical, and implementation experts is available to help you at every stage of product rollout and utilization. We provide implementation, education, and consulting services to help you make the most of the InterQual solutions you use, with options that fit your process, schedule, and budget.

Interrater Reliability

Measure how well, and how consistently, your staff applies InterQual Criteria with this web-based tool to help improve usage and quality within your organization.

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Education

Our education programs help meet your staff development needs with rigorous and effective training options, from introductory end-user training and physician education to advanced instructor certifications.

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Implementation

Benefit from expert knowledge and guidance at the very start. We provide a dedicated team of technical consultants, clinical consultants, and project managers to help you get started with our software solutions. Implementation services are provided for InterQual Review Manager, InterQual Connect and InterQual AutoReview.

 Talk to Sales 1-855-744-3760 

 InterQual Support 1-800-274-8374

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Provider Resources

CASE STUDY
InterQual Case Study – Western Maryland Health System

Case study describing how InterQual helped reduce denials as the health system transitioned to value-based care.

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CASE STUDY
InterQual Case Study - Florida Hospital Orlando

Case study describing how a collaborative approach in the ED reduces inappropriate admissions.

Download Case Study

WHITEPAPER
Reducing Denials

Ten steps to reduce denials, win more appeals, and improve hospital performance.

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FACT SHEET
InterQual Evidence-Based Development Process

This flyer describes the rigorous process used to develop and ensure the integrity of the evidence-based InterQual Criteria.

Download Fact Sheet

Payer Resources

CASE STUDY
InterQual Case Study - Florida Hospital Orlando

Case study describing how a collaborative approach in the ED reduces inappropriate admissions.

Download Case Study

FACT SHEET
InterQual Evidence-Based Development Process

This flyer describes the rigorous process used to develop and ensure the integrity of the evidence-based InterQual Criteria.

Download Fact Sheet

You May Also Be Interested In

InterQual Connect™

An integrated medical review and connectivity solution for payers and providers that enables the automation of prior authorizations requiring a medical review within existing workflows.

Customize InterQual® Criteria

Incorporate custom content to more closely match your medical and business policies with the Customize tool.

InterQual® Ambulatory Care Planning Criteria

Identify when imaging studies, procedures, DME, MDx tests, specialty pharmacy medications, and specialty referral consultations are appropriate.

InterQual®

An evidence-based clinical decision support solution to help payers, providers, and government agencies make clinically appropriate medical utilization decisions.