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Streamline the medical review process with a variety of access options for using InterQual® Criteria. This medical review automation solution increases utilization management (UM) efficiency and …
ASAM partnered with InterQual to develop software for using The ASAM Criteria in utilization review and management workflows. The ASAM Criteria Navigator brings The ASAM Criteria into a structured, …
When we receive a request for authorization or prior approval, our utilization review nurses use Optum’s InterQual® criteria to determine if the services and level of care are clinically indicated.
InterQual criteria, published by Change Healthcare LLC, is used in many of Wellmark’s medical review processes to support the medical necessity of health care services. The InterQual criteria is available …
Below is a summary of changes included in the 2025 InterQual Criteria that Independence Blue Cross and Independence Administrators will begin using on August 18, 2025.
When we receive a request for authorization or prior approval, our utilization review clinicians use InterQual® criteria to determine if the services and level of care are clinically indicated.
InterQual® benchmarks Overview InterQual content includes benchmarks for length of stay, percent paid as Observation, urine drug tes. ing, and surgical site of service. The InterQual benchmark …
Use the most current InterQual® cloud-based criteria to complete reviews without specifying patient data, helping you comply with government DICAP requirements.
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