Optimizing care management

As a payer, you are concerned that clients, members and customers get the right care at the right time in the right setting.

Today, more organizations-payers and providers, public and private-rely on InterQual® than on any other evidence-based clinical decision support to help achieve these goals. Wide adoption of InterQual fosters alignment between payers and providers and focuses all stakeholders on ensuring consistent, clinically appropriate care decisions.

Why InterQual? In the end, all the reasons come down to the same thing: InterQual's ability to help stakeholders improve healthcare quality and efficiency. InterQual helps to:

Reduce over- and under-utilization

  • Drive appropriate care with same source, rules-based, patient-specific EBM (evidence-based medicine) decision support.
  • Reduce re-admissions, LOS (length of stay) and services with integrated tools for complex and co-morbid cases.

Increase defensibility and reduce risk

  • Validate appropriate care with quality indicators, checklists and reporting.
  • Drive cost efficiencies through InterQual Connect™, the InterQual auto authorization solution.

Align stakeholders

  • Drive consistency with same source, rules-based, customizable EBM decision support.
  • Align with CMS guidelines.
  • Reduce administrative expense with fewer denials and appeals.
  • Improve quality with more time available for patient care.

Support stakeholder performance management

  • Facilitate medical and payment policy decisions with rules-based EBM.
  • Identify practice trends and areas for quality improvement.
  • Identify high-quality, high-performing providers for 'gold-carding' and tiered networks.

Frequent updates and enhancements

InterQual Criteria sets are reviewed and updated at least annually; some criteria sets, such as molecular diagnostics, are updated more frequently. We continually monitor new regulations and requirements to help customers meet them, such as quickly offering Quality Indicators when CMS called for these tools.

Throughout the year we release technology updates and enhancements, regularly bringing new functions and features to our customers. For example, we offer an advanced authorization solution via Clear Coverage that raises the bar for automating the entire authorization, coverage determination, notification and even ordering process, reducing cost, saving time and improving care.


  • Flexible access and use-Built for integration, InterQual technology can be combined with your organization's existing applications. With our diverse delivery options, alliance partners and unique ability to incorporate organization-specific criteria, McKesson delivers solutions that are fully integrated with and tailored to your organization's care management workflow.
  • Credibility-The expertise and intense rigor we apply in the InterQual development process results in unparalleled content integrity, so you can have greater confidence in your clinical decision-making, and by sharing the underlying logic you can create greater transparency and alignment between you and your stakeholders.
  • Commitment-The McKesson team is with you every step of the way, dedicated to making your experience-with our criteria, our technology and our professional services-a superior one.

Do you want to know more about how InterQual can help improve healthcare quality, efficiency and costs?