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Solution suite

InterQual

Our evidence-based clinical decision support solution for payers, providers and government agencies who want to help 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

We follow the science and 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

Aligning with CMS: Medicare Content Navigator and InterQual Transparency

Discover how to meet the latest regulatory requirements for Medicare Advantage plans.

Article

Five step InterQual evidence-based development process

The InterQual Criteria is developed through a rigorous, five-step process by our clinical development team.

Product information and resources

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    Case study

    InterQual case study

    Explore how a large national health plan leveraged InterQual® solutions as the catalyst to transforming their UM and CM programs.

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