Solution
InterQual® Behavioral Health Criteria
Evidence-based clinical decision support for payers and providers who want to make the most appropriate care decisions for mental health and substance use.
What’s included in InterQual Criteria for Behavioral Health
Evidence-basedcriteria to support behavioral health decisions
Continuum and Q&A formats to provide timeline guidance
Help move patients safely and efficiently through the continuum of care by presenting all settings of care in one view, which incorporates the episode day/week for level-of-care decisions. Intuitive Q&A format simplifies appropriateness decisions for behavioral health services.
Comprehensive content to consider the whole patient
Determine the appropriate level of care or service by factoring in symptoms, comorbidities, functional status, SDoH risk factors, support-system quality, and more. The solution recommends lower levels of care when the patient is improving and more intense settings when the patient’s condition is deteriorating.
Development process to support mental health parity
Help address mental health parity by using InterQual criteria that are developed using the same evidence-based rigor we apply to—and are not more stringent than—our medical/surgical criteria.
Industry content structured for UM to drive consistent, efficient reviews
Streamline your medical review process by giving users easy access to The ASAM Criteria® and Medicare policies that have been converted into a structured, interactive tool.
Our outcomes
- InterQual® Coordinated Care Discover our cloud-based care coordination solution that helps with complex care management of high-risk members and patients with a single, blended care plan. Learn more
- InterQual® Connect Discover InterQual® Connect, a medical review & connectivity solution that enables the automation of prior authorizations requiring medical review. Learn more
- InterQual® Alliance Partners Join the wide range of leading Health Information Solution companies that partner with InterQual to enable integrated decision support for mutual payer and provider clients. Learn more
- CareSelect® Risk Assessor Discover our EHR-integrated BRCA risk calculator that automates breast cancer risk assessment to drive fast, accurate risk calculation and help reduce burden. Learn more