What is InterQual system?
InterQual® criteria are a first-level screening tool to assist in determining if the proposed services are clinically indicated and provided in the appropriate level or whether further evaluation is required. The first-level screening is done by the utilization review nurse.
What is InterQual used for?
An evidence-based clinical decision support solution for payers, providers, and government agencies who want to help ensure clinically appropriate medical utilization decisions.
Does CMS use InterQual or Milliman?
Notably, the Centers for Medicare and Medicaid Services (CMS), has declined to adopt a proprietary decision support tool like Milliman or InterQual, hewing instead to a broader definition of medical necessity.
How do I access InterQual?
Viewing the InterQual criteria After you sign in with your One Healthcare ID, you can search the InterQual subset criteria by product, keyword or medical code. Click on HELP in the right corner to find InterQual’s instructions for conducting a review.
Who makes InterQual?
Change Healthcare
NEWTON, Mass. –(BUSINESS WIRE)–Change Healthcare today unveiled InterQual® 2019, the latest edition of the company’s flagship clinical decision support solution. The new release builds on Change Healthcare’s tradition of continuous innovation in content and technology.
What is MCG and InterQual?
MCG focuses more on severity of illness and diagnosis. InterQual focuses more on intensity of service required and provides detailed day-by-day guidelines.
What is the difference between MCG and InterQual?
How much does InterQual cost?
InterQual offers an instructor program that trains you to train others. InterQual works with healthcare teams and hosts training programs run by Registered nurses experienced in case management. There is a cost with InterQual which is between $35-$100 after everything is done.
What is the difference between Milliman and InterQual?
Does Aetna use InterQual or MCG?
Some insurance companies (e.g., United, Aetna, Cigna, AvMed, Humana) use the Milliman language, while others (e.g., TRICARE, Blue Cross, Sunshine State) use the InterQual language.
Did Unitedhealthcare buy InterQual?
We will transition to InterQual criteria for all benefit plans effective May 1, 2021. We expect that using InterQual will further streamline our current clinical review processes while helping to reduce clinical decision turnaround times.
Does UHC use InterQual?
What can InterQual do to improve your workflow?
Help improve review times and support consistency by integrating third-party content from CMS and other sources into your InterQual workflow. Improve usability and transparency by providing multiple InterQual access options to meet any need, from desktop to mobile to cloud.
Why are InterQual criteria important to UnitedHealthcare?
We expect that using InterQual will further streamline our current clinical review processes while helping to reduce clinical decision turnaround times. What is InterQual? InterQual criteria are nationally recognized, evidence-based clinical criteria that we’ll use for utilization management for all our benefit plans.
What can InterQual do for mental health care?
Support appropriate care by managing your delivery of mental health and substance use care, including initial and concurrent level‐of‐care decisions. Help improve review times and support consistency by integrating third-party content from CMS and other sources into your InterQual workflow.
What are the criteria for an InterQual medical review?
Assess the safest, most efficient care level by using objective, specific criteria based on severity of illness, comorbidities, complications, and the intensity of services delivered.