Clinical Decision Support (InterQual) Solutions

Improve outcomes and avoid denials

Now more than ever, providers and payers need defensible, consistent decision-making support and an efficient way to proactively manage patient care to reduce length of stay, inappropriate admissions and readmissions, unneeded interventions and, in turn, denials.

With rigorously developed, frequently updated and objective content, InterQual aligns providers and payers with actionable, evidence-based clinical intelligence.

7.8% Shorter hospital stays in InterQual hospitals

Automate routine tasks and focus on the exceptions

Reduce the administrative burden of manually conducting medical reviews and processing prior authorizations, provide/receive quicker authorization approvals, and achieve greater transparency, all within your existing workflows, with our innovative automation solutions, InterQual AutoReview and InterQual Connect.

Move to an exception-based utilization management process that allows you to focus your skilled staff on the exceptions that require their expertise while your systems automatically process the rest.

Reduce time and costs managing MDx test claims

Easily identify the precise test under review and reduce review time with the DEX Diagnostics Exchange, a test identification and policy management solution that connects payers and laboratories to drive appropriate molecular diagnostics coverage and reimbursement.

75% decrease in the time spent on MDx prior authorizations, (Fallon case study)