InterQual solutions are evidence-based decision support products that help payor and provider organizations make sound, timely decisions about an individual’s care to ensure they receive the right care for optimal outcomes and reduced medical costs. InterQual Criteria cover over 95% of all reasons for admission to any level of care and over 95% of procedures and imaging studies performed, including: inpatient and outpatient levels of care, behavioral health, imaging, procedures, molecular diagnostics and retrospective monitoring. InterQual clinical content is delivered via a variety of technology options to fit the varied needs of our customers, and our professional services group provides training, consulting and product support to maximize the value of InterQual offerings.

InterQual Content InterQual is a suite of evidence-based content to help payor and provider organizations make sound, timely medical decisions. The strength of InterQual clinical content lies in a development process that incorporates both the critical appraisal of scientific knowledge and real-world experience, backed by a panel of over 1100 medical professionals with over 16,000 citations, and updated annually.

Level of Care Criteria help reviewers consider a patient’s severity of illness, co-morbidities and complications to guide them toward the most efficient, safest level of care. Content helps reviewers set objective endpoints for service and assess discharge or transfer readiness with built-in checkpoints.

Care Planning Criteria promote clinical quality and cost-effective allocation of resources by identifying optimal timing, sequencing and appropriateness of interventions.

Behavioral Health Criteria help in the selection of appropriate level of care and in demonstrating medical necessity of behavioral health services provided.

Retrospective Monitoring via the SIM plus product helps assess the appropriateness of surgical and non-surgical invasive procedures retrospectively with criteria for checking pathology test results when applicable, as well as for documenting whether a procedure was performed adequately or whether evidence of significant pathology was present and expected.

Clinical Evidence Summaries synthesize the latest evidence-based research on complex diagnoses, conditions and tests to assist medical directors, physician reviewers and practioners in making decisions. In addition to fostering collaboration between healthcare payors and providers, they serve as an EBM reference care managers can use for patient-specific support.

Coordinated Care Content is comprised of blended, holistic and customizable assessments that are then developed into care plans to better enable care managers to manage patients with complex and chronic diseases. Technology Options In close collaboration with our customers we have created an array of options for accessing and applying InterQual Criteria—providing ultimate flexibility in expediting a quality review process while fostering timely, appropriate and consistent care delivery. InterQual is fully integrated with CareEnhance Review Manager, CareEnhance Care Management Software (CCMS) and, through our Alliance Partner program, with more applications than any other criteria.

• McKesson Clear Coverage: Automates the entire authorization process to reduce costs and provider hassles; and leverages InterQual evidence-based support for medical necessity decisions.
• CareEnhance Review Manager: Interactive, browser-based access to InterQual Criteria that facilitates care review communications and standardizes terminology among staff and between health plans and providers, improves workflow and enhances data collection. Review Manager’s customization utility enables you to achieve a single source for all of your clinical review content because it allows you to easily incorporate regional, regulatory and organizational content alongside the InterQual Criteria.
• InterQual Transparency Solution: Give providers access to criteria that are critical to their practices, in an intuitive reference-only format via your portal.
• InterQual Online: Access InterQual via the Web with an affordable, easily implemented and easy to use browser-based application, hosted by McKesson.
• InterQual Online Anonymous Review: Perform reviews on secure patient data with Web-based access to a version of InterQual Online designed to give government users the ability to de-identify specific patient data.
• InterQual View: View InterQual anywhere with the criteria installed on laptops or your intranet.
• Integration: Use InterQual within your existing workflow system via integration—with your own care management system or one of the healthcare information technology products of our more than 20 partners. Services Portfolio McKesson offers a range of services and solutions to improve effective utilization of InterQual Criteria and expand the workflow and quality benefits of Review Manager and the rest of the InterQual suite. McKesson offers customized and packaged solutions, delivered by world-class team of professional consultants and trainers who partner with clients to address key organizational issues that may be technical, clinical or operational in nature. The team brings years of education, global healthcare, IT and strategic consulting experience to meet your needs.
• Business Consulting Services: Our experienced team provides operational efficiency consulting and strategic planning and the tools to help you overcome challenges and better understand your ROI opportunities, take your InterQual solution to the next level to gain greater efficiencies or regain performance that may have been lost over time, and help you to prepare for RAC and other audits.
• Implementation Services: We have successfully guided hundreds of customers through every aspect of the implementation process, applying the right mix of training, consulting and technical services to achieve fast, efficient results. ? Technology and Integration Services: Designed to help InterQual products deliver value quickly, our services include software customization, Web services development, interface construction, hosting and management services. And we partner with leading vendors to provide the most comprehensive technology and integration service offerings in the industry.
• Training and Education Services: Our comprehensive, customized InterQual training programs are offered onsite or via the Web and are designed for a wide spectrum of users who want to learn how to use the product, the latest enhancements or how to train others on the product. We help both new and experienced users get the most from InterQual and conduct more effective reviews with programs such as certified instructor training, physician education, onsite mentoring and system navigation. The InterQual Learning Source offers online training, evaluations and training history for participants and reports for managers.
• Product Support: With a 97% customer satisfaction rate, our product support professionals are available 12 hours a day, five days a week, via a toll-free hotline and email to help you get the most from our solutions. We can access customer desktops for quick technical troubleshooting. Our customer Web site, accessible 24/7, supplies questions and answers and allows users to report issues and keep track of them as well as link to related sites.
• InterQual Interrater Reliability Suite: The IRR Suite is a McKesson-hosted testing application designed to improve consistency in applying InterQual criteria across your organization. Fifteen test sets, updated annually, are available online anytime, anywhere from a browser.
• Certification Program: The Certified Professional Healthcare Management (CPHM) program is a professional certification program to enhance your staff’s healthcare management skills and position your organization to make better care management decisions.