AI-accelerated prior auth reviews for speed and compliance
Prior authorization reviews create costly inefficiencies for payers, leading to slow turnarounds, care delays and friction among stakeholders. InterQual® Auth Accelerator leverages clinically trained AI to accelerate the prior authorization review process. This enables accurate, faster reviews, improved compliance and a better experience for providers and members.
Key features
Exclusive access to InterQual experts for model training
InterQual Auth Accelerator offers exclusive access to proprietary InterQual Criteria and the InterQual content team for AI training. The models are carefully trained, refined and validated to ensure the AI is interpreting and applying the criteria correctly.
Intelligent documentation indexing for easy navigation
Provider-submitted documentation, including PDFs and images, are converted into a searchable format and organized meaningfully for easy navigation and reference during review.
AI-accelerated prior authorization reviews
Submitted documentation is compared with the relevant criteria and policies. For each point, the AI suggests an answer and highlights the supporting evidence within the documentation. This reduces the time required to complete the review and provides transparency into the AI’s suggestion logic.
Highly configurable automation
Organizations can tailor automation, from AI-guided to fully auto-authorized, always keeping human reviewers in the loop for oversight. The solution never auto-denies cases, ensuring all patient care decisions remain firmly in human hands.
Trust through transparency and data
All AI recommendations and interactions are logged for compliance and model refinement. A robust dashboard provides detailed analytics, including tailored ROI metrics. This enables performance tracking and improvement identification, maximizing solution value.
Key benefits
Supports compliance
InterQual Auth Accelerator enables faster turnaround times, supporting alignment with regulatory mandates such as CMS-0057.
Improves efficiency and accuracy
AI-accelerated reviews reduce administrative burden and human error, enabling review that are quick and accurate.
Enables timely access to care
Automation facilitates quicker responses, enabling timely access to care and improving provider and member satisfaction.
Industry insights
Article
Learn what to look for in an AI healthcare partner — from clinical rigor to transparency — to support safe, effective implementation.
On-demand webinar
Discover what to ask AI vendors and how to build a strategy that supports accelerated decision-making, reduces administrative burden and maintains clinical integrity.
Article
See how Optum follows the science where it leads, validating the research we find to uphold the clinical integrity of InterQual content.
Clinical Decision Support Solutions
Solution suite
InterQual
Discover our evidence-based clinical decision support solution for payers, providers and government agencies.
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.
*Based on Optum internal study from initial testing.