Data-driven setting of care guidance for clinical procedures
InterQual® Site of Service helps payers and providers determine the safest, most cost-effective setting for a procedure — while accounting for complex patient considerations and inpatient exceptions. Integrated seamlessly into existing InterQual workflows, this content add-on enables reviewers to efficiently access objective, data-driven benchmarks that support more accurate and confident decision-making.
Key features
Data-driven setting determinations at the CPT code level
Site of Service provides accurate and detailed setting determinations based on claims data at the CPT code level, rather than at the recommendation level.
Setting lookup functionality for an expanded code library
This functionality enables reviewers to determine the appropriate procedure setting without conducting a full medical review, supporting scenarios where only a setting determination is needed. This expanded code library includes CPT codes addressed in the InterQual® Procedures Criteria and those not covered in the criteria.
Inpatient and outpatient data insights and ambulatory benchmarks
Site of Service delivers data insights for inpatient and outpatient designations and ambulatory site of service benchmarks. This visualization of supporting data helps inform setting designations below a 75% threshold and supports organizations in directing procedures to the safest care settings.
Evidence-based alternate setting review
This evidence-based algorithm captures additional clinical factors — such as comorbidities and risk factors — that may justify a change in setting based on a patient’s unique clinical scenario. When a requested inpatient setting does not align with an InterQual or CMS designation, a reviewer may conduct a setting review to gather further clinical information supporting an inpatient setting for a second-level review determination.
Available modules
Site of Service is available as an add-on to the following InterQual® Criteria and industry content modules:
- InterQual® Acute Adult Criteria
- InterQual® Acute Pediatric Criteria
- InterQual® Behavioral Health Services Criteria
- InterQual® Procedures Criteria
- Medicare Procedures Navigator
Key benefits
Efficiency, consistency and accuracy
Site of Service helps decrease administrative burden, improve decision-making accuracy and increase consistency across your organization.
Patient safety
Improve patient safety and outcomes by identifying the safest site of care based on the latest data and evidence.
Cost savings
Site of Service cuts costs and denials by shifting procedures to more appropriate, lower-cost settings — benefiting payers, providers and patients.
Industry insights
On-demand webinar
Explore market conditions driving the outpatient shift, considerations for patient selection and current opportunities in the ambulatory space.
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Evidence-based medicine improves quality of care while reducing the cost of care.
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Learn how the InterQual® team developed objective frailty criteria through a process that ensured clinically applicable content.