Simplify Prior Authorization
Reduce administrative burden by automating the prior-authorization process and eliminating redundant medical reviews.
Increase payer/provider collaboration by removing costly barriers, providing quicker authorization approvals and providing transparency into medical review and authorization criteria.
Streamline the medical review process by integrating into existing workflows.
Gain access to most current clinical guidance through a cloud-based content platform.
Reduce IT burden with an integrated solution that doesn’t require new hardware or software.
Get up and running quickly with an integrated solution and network of alliance partners.
Bring Automation to Existing UM/CM Systems
Medical review service
- Gain immediate access to the most current, cloud-based InterQual Criteria with a modern, user-friendly interface for conducting medical reviews.
- Improve efficiency with access to the Medical Review Service within your existing UM/CM system or via your payer’s provider portal.
- Ensure transparency in the prior-authorization process by enabling payers to publish unique policies which providers can access as they conduct medical reviews.
- Providers can transmit an authorization request across our authorization gateway, complete with an InterQual medical review, directly to a payer. The payer system can then apply business rules and the InterQual Criteria to this request and instantly deliver an automated authorization determination status back through the gateway to the provider.
- Providers can receive quicker authorization approvals for most requests. That means payers only need to touch the exceptions that can’t be approved automatically. The result is no more duplicative medical reviews or wasting of precious staff time on routine authorizations.
- The authorization gateway is proven and secure and currently supports thousands of authorization transactions per week between connected payers and providers.
- Our payer partners are enabling the automation of authorizations by integrating InterQual Connect into their internal UM solutions and provider portals. Current payer partners.
- Our provider partners are streamlining the medical review and prior-authorization process by integrating InterQual Connect into their care management workflows. Current provider partners.
- Our portal partners are integrating InterQual Connect to help payers create online platforms for streamlining the medical review and prior-authorization process. Current provider partners.
The ‘Intelligent’ 278: Creating a Standard for Shared Decision Support
Modifying the HIPAA Healthcare Service Review X12-278 transaction standard could create a new tool to automate prior authorizations.
InterQual Connect™ Explained
This two-minute video explains how InterQual Connect can help automate the prior authorization process.