InterQual® Ambulatory Care Planning Criteria
Identify when imaging studies, procedures, DME, MDx tests, specialty pharmacy medications, and specialty referral consultations are appropriate.
InterQual® Ambulatory Care Planning Criteria help identify when imaging studies, procedures, durable medical equipment, molecular diagnostic tests, specialty pharmacy medications, and specialty referral consultations are appropriate. The criteria can be applied prospectively or retrospectively to manage utilization and identify differences in practice patterns.
The criteria feature extensive informational notes and references that support clinical recommendations and offer guidance to the reviewer in a timely manner. The intuitive Q&A format, available in all Care Planning Criteria, supports efficient review workflows. In addition, the best evidence-based recommendation is suggested within a single workflow where appropriate, according to the clinical scenario presented (e.g., MRI being superior to CT of the head in cases of evaluation for primary brain tumor), thereby allowing you to drive more value from your criteria investment.