InterQual Criteria by Optum
Evidence-based clinical decision support for medical and behavioral health.
Overview
Optum InterQual Criteria is a leading clinical decision support solution used by providers and payers for utilization management, care management, and denial management. It provides evidence-based clinical criteria to guide decisions on patient admissions, level of care, and length of stay, ensuring that care is medically necessary and appropriate.
✨ Key Features
- Evidence-based criteria for medical necessity
- Covers full continuum of care (acute, post-acute, behavioral health)
- Real-time updates to guidelines
- Integration with EHR and case management systems
- Analytics tools to monitor utilization
🎯 Key Differentiators
- Comprehensive criteria sets developed through rigorous evidence-based process
- Widely adopted by both payers and providers, creating a common language
- Strong integration capabilities with major EHRs
Unique Value: Provides trusted, evidence-based clinical criteria to support appropriate utilization of healthcare resources, helping to improve quality of care and manage costs.
🎯 Use Cases (4)
✅ Best For
- Improving patient outcomes and operational efficiency.
💡 Check With Vendor
Verify these considerations match your specific requirements:
- Point-of-care diagnosis and treatment reference
- Drug information lookup
🏆 Alternatives
InterQual is one of the two main industry standards for medical necessity criteria, known for its comprehensive and rigorously maintained content.
💻 Platforms
🔌 Integrations
🛟 Support Options
- ✓ Email Support
- ✓ Phone Support
- ✓ Dedicated Support (All tier)
🔒 Compliance & Security
💰 Pricing
Free tier: N/A
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