Optum InterQual
Evidence-based clinical intelligence to support appropriate care and reimbursement.
Overview
Optum InterQual is a leading solution for utilization management, providing objective, evidence-based clinical criteria to guide decisions on the appropriate level of care. It is used by payers and providers to conduct prospective, concurrent, and retrospective reviews for medical necessity. While not exclusively a drug review tool, its criteria for procedures and condition management inherently involve appropriate medication use and are a key part of the overall utilization management and review process for payers.
✨ Key Features
- Evidence-based criteria for levels of care (Inpatient, Outpatient, Home Care, etc.)
- Modules for Medical, Behavioral Health, and Procedures
- Integration into payer and provider workflows
- AI-enabled case review automation (InterQual AutoReview)
- Supports prior authorization and medical necessity reviews
🎯 Use Cases (3)
✅ Best For
- Use by health plans for utilization management.
- Integration into hospital case management workflows.
💡 Check With Vendor
Verify these considerations match your specific requirements:
- Real-time prescription-level drug interaction checking (this is not its primary function).
💻 Platforms
🔌 Integrations
🛟 Support Options
- ✓ Email Support
- ✓ Phone Support
- ✓ Dedicated Support (Enterprise tier)
🔒 Compliance & Security
💰 Pricing
🔄 Similar Tools in Drug Utilization Review
FDB MedKnowledge
A comprehensive drug knowledge base that integrates into healthcare IT systems to support clinical d...
Wolters Kluwer Medi-Span
An embedded drug database and clinical screening solution that supports decision-making and business...
DrFirst iPrescribe
A mobile e-prescribing app that provides full prescribing capabilities and clinical decision support...
Veradigm ePrescribe
A comprehensive, certified solution for electronic prescribing used by a large network of providers....
CoverMyMeds
A healthcare technology platform focused on streamlining the electronic prior authorization (ePA) pr...
Agadia RxMTM+
A medication therapy management platform for health plans and PBMs to manage CMS-compliant MTM progr...