Change Healthcare Inc. released InterQual® 2022, the latest edition of the company's clinical decision support solution for the delivery of the latest, evidence-based appropriate care. The release includes new criteria for emergent trends, restructured and interactive criteria to streamline workflows, and artificial intelligence to drive proactive insights and efficiency. All updates have been rigorously researched and independently peer-reviewed, so users can feel confident that the criteria are free of bias.

The expansive suite of criteria features new additions and comprehensive content updates such as the inclusion of new American College of Cardiology and American Heart Association guidelines for the management of chest pain, expanded tools for transition planning and social determinants of health assessment for behavioral health patients, and a new content module developed through an exclusive partnership with the American Society of Addiction Medicine . The release also incorporates streamlined workflows for health care providers and health plans alike. The new InterQual Decision Reasons add-on provides organizations easy access to content used to consistently and clearly communicate to patients why a service may not be clinically appropriate.

With the addition of review-sharing functionality, providers can electronically share InterQual reviews with payers, eliminating manual authorization transactions. To further drive authorization efficiency, the InterQual Outpatient Rehabilitation and Chiropractic criteria have been restructured to streamline submissions. Lastly, auto-selection functionality added to Medicare Content Powered by InterQual allows for national or local coverage determinations or Medicare administrative contractors to be automatically selected based on date and service location.

In addition to the updates and enhancements of InterQual 2022, predictive analytics has been added to the InterQual AutoReview solution. These new AI models predict the likelihood of a patient being placed in observation or inpatient status and whether the patient will require a short or long stay. With these advanced insights, case managers can quickly identify cases that require immediate focus, allowing for timely care adjustments and advanced coordination of discharge services.

The combination of predictive analytics with medical-review automation and evidence-based criteria drives proactive, efficient, and defensible utilization management programs.