Optum launches InterQual 2025 to enhance care decisions with evidence-based solutions

• Procedural care is increasingly shifting from inpatient to outpatient settings. InterQual 2025 helps organizations in navigating this transition by providing updated setting determinations using code-level benchmarks, providing more accurate and detailed guidance.

• The new AI-enabled case stratification solution, Case Intelligence, identifies the likelihood of inpatient admission and recommends next steps based on customized workflows. This helps UM teams prioritize reviews and optimize physician advisor time.
• Optum’s medical review automation solution, InterQual® AutoReview, has expanded to cover 90% of condition-specific admission reviews, helping reduce administrative burden, increase efficiency and enhance review accuracy.

• Optum’s Decision Reasons solution provides easy access to content for payers to communicate why a service may not be clinically appropriate, aligned with evidence-based criteria. The content has been expanded to provide more empathetic and personalized communication.

• The new InterQual Community provides clinical resources and support for payers and providers to improve collaboration through a one-stop forum.
• On-demand education courses developed by American Society of Addiction Medicine (ASAM) help organizations access training directly from the medical society for utilizing the ASAM Criteria® in utilization reviews.
• The InterQual® Certified Reviewer program certifies staff who demonstrate appropriate application of the InterQual criteria, helping organizations develop quality reviewers and enhance clinical decision-making.

InterQual 2025 is available in all cloud applications, allowing users to evaluate and enable the new criteria seamlessly.

The ASAM Criteria is a registered trademark of the American Society of Addiction Medicine.