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Solution suite

InterQual

Our evidence-based clinical decision support solution for payers, providers and government agencies who want to helps ensure clinically appropriate medical-utilization decisions. 

Evidence-based criteria and technology for clinical decision making

Our innovative clinical content, technologies, solutions, and services have helped reduce the administrative burden, enhance payer-provider relations, and improve care quality. Our solutions support those committed to the passionate pursuit of quality outcomes without unnecessary cost.

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Clinical Decision Support Solutions

InterQual Criteria

Our comprehensive solution offers clinical decision support designed to strengthen patient outcomes and reinforce appropriate utilization.
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Industry Content Navigator

Structured industry content to support consistent application of third-party content and policies and improve review workflow.
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InterQual Delivery

Streamline the medical review process with a variety of access options for using InterQual® Criteria.
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InterQual AutoReview

A medical review automation solution that increases utilization management (UM) efficiency and review accuracy.
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InterQual Coordinated Care

An integrated, cloud-based care coordination solution for complex care management.
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Related healthcare insights

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Article

Follow science defend against bias

See how Optum follows the science where it leads, validating the research we find to uphold the clinical integrity of InterQual content.

On-demand webinar

Adventist West’s success through redesigning and automating UM

Discover how to leverage automation for centralized, exception-based utilization management.

Article

Promises and pitfalls: AI and clinical decision-making

Learn more about why evidence-based criteria and clinician insight are needed for informed and trustworthy decisions while leveraging AI.