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.

Support Consistent Application of Third-Party Content to Improve Review Workflow and Efficiency

Content from third-party sources is converted into our easy-to-use Q&A format. Policies that exist in disparate sources or are cumbersome to navigate are streamlined and structured using InterQual’s clinical rules and criteria development expertise.

Content powered by InterQual can be incorporated seamlessly into your existing InterQual workflow to create a structured, interactive tool that can help reduce review times, support review consistency, and streamline the prior authorization process. Providing a single source for content helps minimize the need to use and update multiple systems and supports the consistent and efficient application of medical policies.

Industry Content by InterQual are available for:

  • Medicare Procedures - Converts hundreds of Medicare National and Local Coverage Determinations (NCDs and LCDs) for Medicare patients undergoing inpatient or outpatient surgical procedures.
  • Medicare Durable Medical Equipment - Criteria to assist with determining the appropriateness of equipment and accessories. The criteria is strictly aligned with Medicare National and Local Coverage Determinations (NCDs/LCDs) and related articles to address Medicare Advantage and Medicare fee-for-service cases.
  • Medicare Molecular Diagnostic and Lab - Criteria to support the consistent and efficient application of medical policies for Medicare patients undergoing molecular, genetic or laboratory testing.
  • Third party content - InterQual works with a variety of organizations to convert their proprietary content into our structured, actionable format.

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