Streamline SUD reviews with interactive access to The ASAM Criteria
The ASAM Criteria® is a widely used evidence-based standard for determining the safest, least restrictive level of care for individuals with substance use disorder and co-occurring conditions.
Developed through a preferred partnership with the American Society of Addiction Medicine (ASAM), The ASAM Criteria® Navigator brings these standards into a structured, interactive tool for utilization management (UM). It helps streamline medical reviews, improve consistency, and support alignment with CMS-1115 waiver requirements and state mandates.
Key features
Exclusive interactive access to The ASAM Criteria
Only Optum offers interactive access to The ASAM Criteria for the purpose of utilization review and regulatory compliance through a preferred partnership with ASAM.
Integrates seamlessly within your UM workflow
The ASAM Criteria are seamlessly integrated into the existing InterQual® cloud solutions workflow to create a structured, interactive tool that helps streamline the medical review process. Integration with payer’s provider portals is also available for more efficient authorizations.
Streamline reviews with an intuitive Q&A format
Easy-to-use Q&A format helps improve efficiency and consistency. Starting with the requested level of care, the algorithm guides reviewers to a recommendation, including services for co-occurring conditions. Users can complete reviews in under 15 minutes.
Supporting IRR tool, education and training
Interrater reliability (IRR) testing is included to help provide consistency and accuracy of criteria application as required by NCQA, URAC or state regulations (payers).
Basic education is included and consists of self-paced learning modules and virtual instructor-led sessions for the 3rd and 4th edition criteria.
ASAM-approved supplemental education is also available to support the transition to the 4th edition. This program is delivered via an on-demand webinar and is followed by an expert-led office hours session.
Key benefits
Accuracy and confidence
Make confident UM decisions, stay up to date with evolving standards and transition smoothly to the 4th edition.
Efficiency
Decrease review time and administrative burden with a single workflow that transforms static criteria into easy-to-use, actionable guidance.
Consistency and alignment
Help reduce reviewer variation and align with accreditation standards using standardized content and built-in IRR testing.
Compliance support
All content is consistent with The ASAM Criteria, helping you meet increasing state mandates that require its use in SUD reviews.
Interoperability
Our solution supports alignment with interoperability requirements by enabling the use of FHIR-based content within UM workflows.
Industry insights
On-demand webinar
Explore the development of The ASAM Criteria® Fourth Edition and discover tools and programs available to support your transition.
Article
Explore how evidence-based tools like The ASAM Criteria® Navigator and InterQual® Substance Use Disorders Criteria are helping payers and providers efficiently and effectively navigate the complex substance use disorder landscape today.
On-demand webinar
Learn how to streamline efficiency and consistency of the utilization review process.
Complementary solutions
Software
InterQual Criteria
Our comprehensive solution offers clinical decision support designed to strengthen patient outcomes and reinforce appropriate utilization.
Software
InterQual Delivery
Streamline the medical review process with a variety of access options for using InterQual® Criteria.
Software
LOCUS Navigator
Streamline the medical review process for behavioral health patients using the LOCUS™ tool within your InterQual® workflow.
The ASAM Criteria® is a registered trademark of the American Society of Addiction Medicine.