InterQual Technology

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® Digital Criteria Hub offers exclusive access to digitized InterQual Criteria, a robust suite of industry content, and custom policies through interoperable FHIR APIs. This enables seamless integration into provider workflows at the point of care.

It supports CMS-0057 Prior Authorization Requirements Documentation and Decision (PARDD) API compliance, centralizes policy storage for easier management, and lays the foundation for AI and automation to accelerate health plan innovation and reduce administrative burden.

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.

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.