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Solution

InterQual AutoReview

Our cloud-based medical review automation solution increases utilization management (UM) efficiency and review accuracy.

Transform UM with AI, automation and clinical evidence

Our solution 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.

What's included in InterQual AutoReview

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

Leverage objective, codified InterQual criteria to support appropriate and provide transparent, defensible documentation for reimbursement, including embedded data from EHRs.

Key benefits

Improve transparency and defensibility. 

Increase efficiency

Reduce administrative burdens by automatically populating InterQual medical reviews with data from your EHR within your existing workflow. 

Improve accuracy

Increase payer trust with accurate, transparent medical reviews that contain embedded EHR data for each objective criteria point

Schedule a demo

Let us show you how to leverage our comprehensive, evidence-based clinical support solutions. 

Related healthcare insights

On-demand webinar

Optimizing UM with InterQual AutoReview

An Optum expert explains how hospital systems can transform their UM programs and drive efficiency with InterQual AutoReview.

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.

Complementary solutions

InterQual Criteria

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

InterQual[HJ1] Delivery

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

See how we can help you improve your medical review process

Current customer resources

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Our dedicated support team is available 24/7 to assist you. 


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