Transform Utilization Management
Reduce your administrative burden with automated medical reviews delivered right to your UM/CM workflow.
Increase trust and transparency with medical reviews that contain clinical values extracted directly from the EHR.
Improve care by enabling utilization review nurses to operate at the top of their license.
Enable real-time clinical decision-making that can potentially reduce inappropriate admissions and denials.
Get Integrated, Automated and Accurate Medical Reviews Right from your EHR
Integrated into your existing UM/CM workflow
- As a flexible, software-as-a-service (SaaS) solution that is integrated into leading EHR applications and case management systems, implementation is fast and easy.
- Because case managers can see which patients have received reviews, they’re able to prioritize activities and focus on the exceptions that require their expertise.
Automated medical reviews with data from your EHR
- Using the diagnosis as a guide, InterQual AutoReview extracts the necessary data from the EHR to conduct automated reviews and then map them to codified InterQual criteria to create InterQual Initial and Episode Day 1 Review.
- Medical reviews include the specific data used to satisfy each criteria point within the review. This provides transparency into the clinical evidence that the review is based on and helps reduce manual errors.
- Auto-generated reviews can be transmitted to payers to provide greater trust and transparency in the review process.
Real-time clinical decision support
- Initial Reviews, conducted at the time of admission, generate immediate notifications in the EHR to indicate which level of care the patient has met.
- Instant notifications, based on the InterQual medical review, can offer insights into how the existing clinical data aligns with evidence-based criteria for medical necessity.
Driven by InterQual Criteria
- InterQual AutoReview leverages specially codified InterQual Criteria adapted to support the automated process.
- InterQual Acute Adult Criteria has been codified to enable InterQual AutoReview to determine the appropriate level of care for patients admitted in the ED, using real-time data extracted from the EHR.
- Additional InterQual Criteria will be codified to support other UM reviews. Contact us for more information about pending releases.
Reinventing ED Case Management with Automation
View this webinar to see how automating the InterQual® medical review can lead to earlier identification of potential denials, quicker review of admission appropriateness, and a closer partnership with commercial payers.
Reinventing Utilization Management to Bring Value to the Point of Care
Current technology can enable collaborative, exception-based utilization management that reduces costs and benefits both payers and providers.
How Automation is Changing the Role of the Case Manager
Learn how the disruptive technology of InterQual AutoReview can feed clinical insights into your existing case management workflow, giving you a real-time view of your patients that allows you to take a more proactive role.
The Value of Case Management in the ED
Learn how staffing case managers in the ED can help hospitals optimize admissions, decrease costs, and improve patient care.
InterQual AutoReview™ Explained
This two-minute video explains how InterQual AutoReview™ can help transform utilization management to be automated, exception-based, and informed by clinical data.
InterQual AutoReview™ for Admission Decisions
Learn how InterQual AutoReview™ can help case managers spend less time on administrative tasks and more time managing patient care.