Access your InterQual Criteria in the way that works best for you
Through a range of options, we can tailor delivery of the InterQual® Criteria to help streamline your medical review process, align payers and providers, and transform utilization management.
What's included
InterQual Medical Review Service
Seamlessly conduct an InterQual medical review within your existing workflow using the most current, cloud-based InterQual Criteria. Our easy-to-use, interactive format helps you navigate through the criteria to reduce review times, support review consistency and streamline the prior authorization process.
With review share functionality, medical reviews are shared electronically between providers and payers. Health plans can also enable automated authorization for requests that require medical necessity review by integrating Medical Review Service within the provider portal.
InterQual Anonymous Review
Safeguard PHI with interactive InterQual medical reviews in a user-friendly interface that complements the case manager’s workflow. Use the most current InterQual cloud-based criteria to complete reviews without specifying patient data, helping you comply with government DICAP requirements.
InterQual Transparency
Comply with regulations and adhere to NCQA guidelines by making your clinical decision-making criteria transparent to providers, members, and non-members. InterQual Transparency is an integrated cloud-based solution that provides publicly accessible, read-only access to InterQual Criteria and custom policies from your website and within your secure member and provider portals.
Key benefits
Flexible options for accessing InterQual Criteria and conducting medical necessity reviews.
Streamline the review process
Improve efficiency and accuracy of utilization reviews with InterQual Medical Review Service our interactive, integrated solution.
Safeguard PHI
Complete reviews without specifying patient data and comply with government DICAP requirements using InterQual Anonymous Review.
Enable transparency with criteria sharing
Meet regulations and adhere to NCQA guidelines by making your decision-making criteria accessible to providers, members, and non-members.
Schedule a demo
Find out how we can help you streamline the medical review process.
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