Medical necessity criteria to support appropriate clinical decisions
In an industry undergoing rapid change, it’s crucial to choose a partner you can trust — one with a shared vision who can help you achieve your strategic objectives. For decades, the InterQual® Criteria team has upheld a singular vision of improving patient outcomes by advocating and supporting evidence-based care.
As health care continues to evolve, so will InterQual. We offer regular releases that support those committed to the pursuit of quality outcomes without unnecessary cost.
Our innovative clinical content, technologies, solutions and services have helped our more than 4,500 customers:
- Reduce administrative burden
- Enhance payer-provider relations
- Improve care quality
Unmatched clinical integrity
Objective, specific and comprehensive clinical content
InterQual Criteria are objective and specific, helping guide consistent, defensible decisions that ensure appropriate, quality care. The portfolio offers comprehensive content that spans the continuum of care for medical and behavioral health.
Rigorous, evidence-based development process
Our highly trained clinical development team performs an unbiased, systematic review and critical appraisal of the evidence using elements of the GRADE approach to help ensure InterQual criteria reflect the best available clinical evidence.
Extensive peer review
Our clinical review panel of more than 1,200 independent, multidisciplinary experts provides extensive, multilevel peer review. Our experts help ensure InterQual Criteria reflect the latest standard of care and best practice.
Content suites available
We provide objective, comprehensive content across the medical and behavioral health continuum of care.
InterQual® Level of Care Criteria
Assess clinical appropriateness with specific criteria for admission, level of care, visit recommendations and maintenance therapy.
InterQual® Behavioral Health Criteria
Criteria help manage the delivery of mental health and substance use care, including initial- and continued-stay level-of-care decisions.
InterQual® Ambulatory Care Planning Criteria
Identify the appropriateness of ambulatory interventions and ensure the appropriate sequencing of care alternatives with these criteria.
Content add-ons available
These offerings are available as add-ons to the InterQual Criteria and industry content modules.
Decision Reasons
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Complementary solutions
Solution suite
InterQual
Discover our evidence-based clinical decision support solution for payers, providers and government agencies.
Software
InterQual AutoReview
This medical review automation solution increases utilization management (UM) efficiency and review accuracy.
Software
InterQual Delivery
Streamline the medical review process with a variety of access options for using InterQual® Criteria.