JSON twin: https://www.healthaidb.com/software/interqual-autoreview.json
Optum
Cloud-based automation that runs InterQual evidence-based criteria against real-time EHR data to perform medical necessity and utilization management reviews.
InterQual AutoReview is a SaaS solution from InterQual/Optum (formerly Change Healthcare/McKesson) that automates Initial and Episode Day 1 medical necessity reviews by extracting clinical data from the EHR, applying InterQual criteria, and delivering determinations or worklists into UM/case management workflows to reduce manual chart review and speed authorization and level-of-care decisions.
2011
P0825
2025-09-07
proprietary commercial
Commercial SaaS pricing; contact vendor for licensing, implementation and per‑user or per‑facility subscription quotes; no public list prices.
enterprise_quote
product
1.0
{
"company_name": "Optum",
"company_url": "https://www.optum.com",
"company_offices": [
"United States",
"Brazil",
"India",
"Ireland",
"United Kingdom"
],
"company_founding": "2011",
"product_url": "https://business.optum.com/en/operations-technology/clinical-decision-support/interqual/autoreview.html",
"categories": [
"clinical",
"clinical decision support",
"utilization management",
"provider utilization review",
"administrative"
],
"market_segment": [
"enterprise"
],
"links": [
"https://business.optum.com/en/operations-technology/clinical-decision-support/interqual/autoreview.html",
"https://business.optum.com/en/operations-technology/clinical-decision-support/interqual.html",
"https://business.optum.com/en/support.html",
"https://business.optum.com/en/operations-technology/clinical-decision-support/interqual/criteria.html",
"https://elion.health/products/interqual-autoreview",
"https://www.g2.com/products/interqual-autoreview/reviews",
"https://mma.prnewswire.com/media/690650/Change_Healthcare_InterQual_AutoReview_Brochure.pdf?p=pdf",
"https://mms.businesswire.com/media/20191217005146/en/763340/1/Change_Healthcare_InterQual_AutoReview_Brochure.pdf?download=1",
"https://customercare.optum.com/public/home.html"
],
"summary": "Cloud-based automation that runs InterQual evidence-based criteria against real-time EHR data to perform medical necessity and utilization management reviews.",
"description": "InterQual AutoReview is a SaaS solution from InterQual/Optum (formerly Change Healthcare/McKesson) that automates Initial and Episode Day 1 medical necessity reviews by extracting clinical data from the EHR, applying InterQual criteria, and delivering determinations or worklists into UM/case management workflows to reduce manual chart review and speed authorization and level-of-care decisions.",
"target_users": [
"utilization management nurses",
"case managers",
"clinical reviewers",
"hospital administrators",
"health plans/payers",
"care coordinators"
],
"specialties": [
"acute care / inpatient medicine",
"obstetrics",
"behavioral health",
"post-acute care",
"emergency medicine",
"surgical services",
"rehabilitation"
],
"regions_available": [
"United States"
],
"languages_supported": [
"English"
],
"pricing_model": "enterprise_quote",
"pricing_details": "Commercial SaaS pricing; contact vendor for licensing, implementation and per‑user or per‑facility subscription quotes; no public list prices.",
"license": "proprietary commercial",
"deployment_model": [
"cloud/SaaS"
],
"os_platforms": [
"Web"
],
"features": [
"Automated medical reviews",
"EHR hub for data extraction",
"Robotic process automation (RPA)",
"Natural language processing (NLP) for unstructured data",
"Extraction and analysis of structured and unstructured EHR data",
"Run automated reviews on admission or on-demand",
"Populate InterQual medical reviews with EHR data",
"Transmit reviews to case management systems",
"Transmit finalized reviews to payers",
"Embedded InterQual criteria for objective, codified review",
"Improves utilization management (UM) efficiency and review accuracy",
"24/7 customer support"
],
"optional_modules": [
"InterQual Criteria (complementary)",
"InterQual Delivery (access/delivery options)"
],
"integrations": [
"Case management systems",
"Payer systems",
"EHR systems (unnamed)"
],
"data_standards": [],
"api_available": "",
"system_requirements": "",
"compliance": [],
"certifications": [],
"security_features": [],
"privacy_features": [],
"data_residency": "",
"customers": [
"Adventist Health (Adventist West)",
"Memorial Hermann",
"Catholic Health"
],
"user_reviews": [],
"ratings": [
"G2: insufficient reviews to provide a rating (2025)",
"SourceForge: product page listed (no aggregated rating)"
],
"support_channels": [
"email",
"phone",
"ticketing",
"community",
"24x7",
"sales"
],
"training_options": [
"documentation",
"webinars",
"live_online",
"onsite",
"on-demand webinars"
],
"release_year": "",
"integration_partners": [
"Advantasure",
"Agadia",
"Assurecare",
"Availity",
"Carevention",
"Casetrakker",
"Cedargate",
"Chordline",
"Cognizant",
"Conduent",
"Datagenix",
"GoEngen",
"Kepro",
"Evolent",
"EXL Service",
"HealthEdge",
"Gainwell Technologies",
"Medecision",
"Pega",
"Salesforce"
],
"id": "P0825",
"slug": "interqual-autoreview",
"type": "product",
"version": "1.0",
"last_updated": "2025-09-07",
"links_json": {
"self": "https://www.healthaidb.com/software/interqual-autoreview.json"
}
}