Accurate, Objective Decision Support & Innovative Capabilities

No matter where or to whom health care is delivered, whether a payer or provider, the priority is the same: providing quality care efficiently. The foundation of the Decision Management portfolio is our market-leading clinical criteria, InterQual®—which help payers and providers consistently apply evidence-based clinical decision support to help ensure provision of the most appropriate care. In addition, our technology solutions help reduce administrative cost through streamlined medical reviews, auto-authorization, network compliance guidance, and molecular diagnostics identification and management.

Our Decision Management Solutions can help you make clinically appropriate medical utilization decisions by enabling:
  • Consistent delivery of quality care, based on evidence
  • Shared clinical language between health plans and providers
  • Reduction of unnecessary medical expense
  • Automated medical review and authorization to reduce administrative expense

Thousands of organizations – payers, providers, government agencies – use our Decision Management Solutions. With nearly 40 years of development, InterQual was the first to provide health care organizations with trusted evidence-based decision-support criteria. Our extensive team of clinical experts and technology specialists continue to provide the most updated medical decision support criteria available as well as lead the way with innovations that help reduce administrative costs and improve quality care.