What are InterQual SmartSheets?

InterQual® SmartSheets provide a concise format of InterQual Criteria that helps facilitate communication between payers and providers.

What is McKesson InterQual?

McKesson’s InterQual® content portfolio helps support better patient outcomes through. integrated, streamlined care management processes and evidence-based appropriateness of. care decision support. The InterQual content portfolio consists of four product sets: • InterQual Level of Care Criteria.

Is McKesson a clearinghouse?

McKesson Clearinghouse Transmission Payers Processing Services | CA.

What is the difference between utilization management and case management?

The key differences between the two models are the integration of utilization management into the role of the case manager versus the separation of the role through the addition of a third team member. Some hospitals have separated out the functions in an attempt to lower overall costs.

What is the purpose of InterQual?

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.

Is InterQual a software?

A cloud solution for providers who want to apply AI to real-time data extracted from the EHR for patient-specific prediction and proactive insight while automatically completing the InterQual® medical review.

What is the difference between Milliman and InterQual?

InterQual’s criteria are, in some respects, stricter than Milliman’s, with more precise clinical benchmarks for each level of care. That could mean an uptick in denials for cases in which the patient is borderline for inpatient vs. observation or discharge vs. continued stay.

What are the InterQual criteria?

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.

Who uses InterQual?

The InterQual® criteria are used by the utilization review nurses when conducting inpatient and post-acute utilization review. InterQual® criteria are clinically based on best practice, clinical data and medical literature.

Which insurance companies use InterQual?

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.

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