Streamline the medical review process with a variety of access options for using InterQual® Criteria. This medical review automation solution increases utilization management (UM) efficiency and …

If you're considering a career pivot in the remote nursing world, read this guide to MCG and InterQual, two essentials for remote nursing jobs.

Unparalleled, objective criteria supporting value-based care across the continuum of care InterQual® Criteria – Industry-leading medical necessity criteria that supports payers and providers in the …

The online help provides a step-by-step guide for you to refer to as you use the application to work with InterQual Criteria. It also includes job aids and video tutorials.

When we receive a request for authorization or prior approval, our utilization review nurses use Optum’s InterQual® criteria to determine if the services and level of care are clinically indicated.

Sep 9, 2025 · 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 …

criteria to be met. This is called a selectable rule (or checkable rule) and occurs when both the criteria point at the same level as the rule and the underlying criteria

· At the Critical level of care, added criteria for a history of congenital heart disease, prosthesis, implanted material, or implanted device to allow for monitoring of high-risk patients

When we receive a request for authorization or prior approval, our utilization review clinicians use InterQual® criteria to determine if the services and level of care are clinically indicated.

InterQual criteria, published by Change Healthcare LLC, is used in many of Wellmark’s medical review processes to support the medical necessity of health care services. The InterQual criteria is …