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Who owns InterQual criteria?

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 InterQual medical necessity 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.

What is InterQual?

® An evidence-based clinical decision support solution to help payers, providers, and government agencies make clinically appropriate medical utilization decisions.

What is the difference between InterQual and Milliman?

While both guidelines use Severity of Illness and Intensity of Service to reach a determination, the primary difference between the two approaches is the emphasis each set of guidelines places on the two factors. MCG focuses more on severity of illness and diagnosis.

What is InterQual and MCG?

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 InterQual certification?

InterQual Certified Instructor Program. A “train-the-trainer” program that provides qualified clinical instructor candidates with the knowledge and materials to train others within their organization.

How are InterQual criteria used in utilization review?

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.

How are InterQual level of care criteria used in healthcare?

InterQual Level of Care Criteria help healthcare organizations assess the clinical appropriateness of patient services across the continuum of care: prospectively, concurrently or retrospectively. Robust clinical detail allows organizations to consider in real time the severity of

What are the criteria for meeting the InterQual?

Meeting Interqual usually requires two separate sets of criteria: Severity of Illness (SI): documentation of the ED diagnosis or diagnoses (not chief complaint). It is not enough to document the patient has shortness of breath; you must try to describe how sick the patient is.

When do InterQual Loc criteria need to be updated?

The criteria are updated continually and released annually. 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.

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