Transform UM with AI, automation and clinical evidence
InterQual® AutoReview applies artificial intelligence (AI) to real-time clinical data extracted from the electronic health record (EHR) and robotic process automation to create and populate InterQual medical necessity reviews.
Key features
Automated medical reviews
Our EHR hub, robotic process automation and natural language processing extract and analyze both structured and unstructured EHR data. You can run automated reviews upon admission when a diagnosis is available or on-demand. Transmit reviews directly into case management systems, ready to be approved, finalized and transmitted to the payer.
Embedded EHR data
InterQual AutoReview uses objective, codified InterQual Criteria to support appropriate care and generate transparent, defensible documentation for reimbursement. Automated reviews are completed without human intervention and include embedded data directly from the source of truth — the EHR.
Key benefits
Drive efficient, proactive and defensible case management with InterQual AutoReview.
Increase efficiency
InterQual AutoReview automatically maps clinical data to the InterQual Criteria, generating a completed medical review. It integrates directly into your existing UM workflow, streamlining processes and reducing administrative burden.
Improve accuracy
Automated reviews eliminate manual data-entry errors and contain the clinical values extracted from the EHR. The result is an accurate, defensible medical review that provides the necessary documentation to help increase payer trust and reduce denials.
Trust and defensibility through AI, automation and clinical evidence
Pairing InterQual AutoReview with Case Intelligence, our AI-enabled case stratification solution, empowers UM teams to work proactively while fostering transparency and trust through automated reviews.
Related healthcare insights
On-demand webinar
An Optum expert explains how hospital systems can transform their UM programs and drive efficiency with InterQual AutoReview.
On-demand webinar
Discover how to leverage automation for centralized, exception-based utilization management.
Article
Learn more about why evidence-based criteria and clinician insight are needed for informed and trustworthy decisions while leveraging AI.
Product information and resources
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Case study
Adventist West case study
Discover how Adventist West used InterQual® AutoReview to drive UM efficiency and improve workflows for significant cost savings.
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Case study
Memorial Hermann case study
Explore how Memorial Hermann utilized InterQual® AutoReview as part of a system-wide UM transformation initiative, helping to drive efficiency, improve review accuracy and decrease cases that required secondary review.
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Case study
Catholic Health case study
Learn how Catholic Health improved UM efficiency with InterQual® AutoReview, enhancing speed and accuracy.
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Case study
Baptist Health case study
Discover how Baptist Health optimized their case management program through centralization and the integration of InterQual® AutoReview.