What are InterQual guidelines?
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.
Where can I find 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 are InterQual informational notes?
Informational notes are listed throughout the InterQual criteria. These provide valuable information and clarifying details. In addition to the informational notes, care management notes, are also available. You will see them highlighted in turquoise.
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.
What is the difference between MCG 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.
What is the difference between InterQual and MCG?
Is McKesson Change Healthcare?
IRVING, TEXAS — March 10, 2020 — McKesson Corporation (NYSE:MCK) today announced the completion of the split-off of PF2 SpinCo, Inc. (“SpinCo”), which held McKesson’s interest in Change Healthcare LLC (“Change Healthcare”) and which was merged with and into Change Healthcare Inc.
What insurance companies use InterQual?
Companies Currently Using InterQual
| Company Name | Website | Sub Level Industry |
|---|---|---|
| Alameda Health System | alamedahealthsystem.org | Hospitals & Clinics |
| Fidelis Care | fideliscare.org | General Health Insurance & Services |
| Humana | humana.com | General Health Insurance & Services |
| CHRISTUS Health | christushealth.org | Hospitals & Clinics |
How long has InterQual been around?
Late 1970s: InterQual, Inc., is founded, and the company publishes the first severity of illness/intensity of service (SI/IS) criteria for acute care, making practical review of the appropriateness of hospitalization possible.