Change Healthcare (InterQual)
Evidence-based clinical decision support for medical necessity and appropriate care.
Overview
InterQual from Change Healthcare (part of Optum) is a widely used set of clinical criteria that helps payers and providers determine the appropriateness of medical services. The criteria are embedded in technology solutions that integrate with provider and payer workflows to facilitate utilization management, care management, and denial prevention.
✨ Key Features
- Evidence-based criteria for medical necessity
- Levels of care criteria (Inpatient, Observation, etc.)
- Utilization management workflow tools
- Integration with EHRs and case management systems
- Peer-reviewed, transparent development process
🎯 Key Differentiators
- Long-standing, widely adopted criteria set
- Broad range of criteria covering the continuum of care
- Transparent, evidence-based methodology
Unique Value: Helps ensure that patients receive appropriate, medically necessary care while enabling providers and payers to manage resources effectively.
🎯 Use Cases (5)
✅ Best For
- Used extensively by hospitals and health plans to ensure that care is medically necessary and delivered at the appropriate level.
💡 Check With Vendor
Verify these considerations match your specific requirements:
- Point-of-care diagnosis and treatment guidance
- Drug information lookup
🏆 Alternatives
InterQual and MCG are the two primary competitors in this space, with different criteria and review philosophies, but similar goals.
💻 Platforms
🔌 Integrations
🛟 Support Options
- ✓ Email Support
- ✓ Phone Support
- ✓ Dedicated Support (All tier)
🔒 Compliance & Security
💰 Pricing
Free tier: N/A
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