What is InterQual case management?

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 are InterQual criteria?

Clinical decision support for providers and payers who want to assess safe and efficient level of care based on illness severity, comorbidities, and complications.

How do I access InterQual criteria?

Viewing the InterQual criteria To help you understand determinations based on the InterQual clinical criteria, we give you access to a read-only version of the criteria at UHCprovider.com/policies > Clinical Guidelines > InterQual Clinical Criteria.

What is InterQual certification?

Answer: 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 InterQual 2020?

An evidence-based clinical decision support solution for payers, providers, and government agencies who want to help ensure clinically appropriate medical utilization decisions.

What is the difference between Milliman 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.

Who owns InterQual criteria?

UnitedHealth Group
While UHC framed its decision as a response to provider requests, it coincides with the recent purchase of Change Healthcare, which maintains the InterQual Criteria, by Optum, the healthcare analytics company owned by UHC’s parent company, UnitedHealth Group.

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.

Who owns InterQual?

What insurance companies use InterQual?

Companies Currently Using InterQual

Company Name Website Sub Level Industry
Unitedhealth Group unitedhealthgroup.com Insurance & Managed Care
CHRISTUS Health christushealth.org Hospitals & Clinics
Providence Health & Services standardlife.com Insurance
Humana aetna.com Insurance & Managed Care

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.

Who is InterQual owned by?