InterQual solutions provide health care providers and health plans nationwide with evidence-based, independently peer-reviewed criteria and workflow enhancements to streamline utilization management
The expansive suite of criteria features new additions and comprehensive content updates such as the inclusion of new American College of
“Driscoll Health Plan’s Utilization Management department has relied on InterQual® Criteria for more than 20 years for objective and leading-edge clinical decision support. Our teams find it user-friendly, and with it being a cloud-based solution, new releases are instantly accessible with no IT lift. We look forward to what InterQual 2022 has to offer with its expanded and updated criteria and technology-enabled, simplified processes,” said
The release also incorporates streamlined workflows for health care providers and health plans alike. The new InterQual Decision Reasons add-on provides organizations easy access to content used to consistently and clearly communicate to patients why a service may not be clinically appropriate. With the addition of review-sharing functionality, providers can electronically share InterQual reviews with payers, eliminating manual authorization transactions. To further drive authorization efficiency, the InterQual Outpatient Rehabilitation and Chiropractic criteria have been restructured to streamline submissions. Lastly, auto-selection functionality added to Medicare Content Powered by InterQual® allows for national or local coverage determinations or Medicare administrative contractors to be automatically selected based on date and service location.
In addition to the updates and enhancements of InterQual 2022, predictive analytics has been added to the InterQual AutoReview solution. These new AI models predict the likelihood of a patient being placed in observation or inpatient status and whether the patient will require a short or long stay. With these advanced insights, case managers can quickly identify cases that require immediate focus, allowing for timely care adjustments and advanced coordination of discharge services. The combination of predictive analytics with medical-review automation and evidence-based criteria drives proactive, efficient, and defensible utilization management programs.
“As with every InterQual release, we are committed to following the science and maintaining the utmost clinical integrity. The technology enhancements we’ve added build upon the foundation of objective evidence to drive efficiencies, payer-provider connectivity, and improved outcomes. It’s exciting to be a part of a holistic solution that combines the latest evidence and responsibly uses technology, such as AI, to help bring efficiency, greater insight, and improved outcomes to utilization management,” said
InterQual 2022 is available in all cloud applications as soon as it’s released, with no installation necessary. To learn more about the enhancements, new functionality, and suite of InterQual solutions, visit our InterQual 2022 webpage.
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