Bring Greater Automation and Accuracy to the InterQual Review Process

CareEnhance®  Review Manager Enterprise (Review Manager) software helps automate and streamline the care review process by combining the InterQual Criteria with an intuitive user experience, data management, and aggregated reporting.

URAC Accreditation SealImprove accuracy and efficiency  

Review Manager’s easy-to use interface and clearly defined workflows guide users through the InterQual Criteria, resulting in greater efficiency and a more consistent review process. Review Manager allows users to prioritize reviews, add important information, and schedule follow-up reviews for a specified date.

Develop insights

Review Manager’s reporting capabilities provide insights into productivity and utilization management outcomes, helping to identify and improve practice patterns. For example, managers can track review completion times by facility, then use that information to identify opportunities for improvement.

Review Manager offers more than 40 predefined reports, the ability to customize reports with no programming skill required, and the ability to import reports designed using SAP® Crystal Reports®.

Collaborate and connect

With Review Manager, organizations can electronically share medical necessity reviews internally, along with essential patient information (e.g., diagnosis codes and patient/member identifiers). This enables real time collaboration between clinicians, saving rework, errors and effort. The secure review transmission capability helps automate prior authorizations. It enables providers to send medical review and authorization requests to payers that have InterQual Connect™.

Download the Review Manager Fact Sheet

Add-on Solutions

To work in conjunction with Review Manager, we offer the following:

  • CareEnhance® Review Manager Enterprise Plus Pak. Enhanced workflow supports management of both discharge planning and denials based on medical necessity. This add-on solution encourages proactive care, reduces paperwork, and helps identify dollars recovered and areas for improvement that can affect the bottom line.
  • CareEnhance® Review Manager Enterprise Integration Toolkit. This solution enables partners to integrate Review Manager with their care management applications.
  • InterQual Transparency. This application allows licensed criteria to be placed on a portal for providers to view, helping boost consistency in decision-making.
  • InterQual Anonymous Review. This McKesson-hosted system lets providers to perform an interactive review with the InterQual® Criteria without specifying patient data, and then transfer the results into another application, so a review can be processed without revealing PHI.
  • InterQual Historical Criteria. This solution helps you assess the appropriateness of care for audited claims using criteria in effect at the time of service.

Additional Decision Support Options

Health care organizations looking for more basic electronic access to their InterQual criteria sets can choose from the following:

  • InterQual View, which gives read-only access to a desktop copy of licensed criteria
  • InterQual Online, which gives read-only Internet access to licensed criteria

Optimize your team’s use of InterQual

  • InterQual Interrater Reliability Suite. Measure how well and how consistently your staff applies InterQual Criteria with this Web-based tool to help improve usage and quality within your organization.
  • InterQual Content Customization Tool. Author and edit guidelines to incorporate locally developed business and medical policies into a single workflow with your licensed InterQual Criteria.