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Introducing InterQual 2025

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Supporting appropriate care and a better patient experience

We are pleased to share that InterQual® 2025 is now available. These enhancements deliver new criteria and functionality that will help optimize safety, education and transparency. Our innovative technology solutions bring artificial intelligence (AI) and automation into your workflow, reducing friction and connecting stakeholders to build a seamless and efficient healthcare ecosystem.
 

Below are a few highlights from this release

Using data and evidence to determine the safest and most appropriate patient setting

With clinical advancements, regulatory changes and the consumer demand for a better patient experience, procedural care is increasingly shifting from the inpatient to the outpatient setting.1,2,3 To aid organizations navigating this transition, InterQual setting determinations have been updated using code-level benchmarks to provide more accurate and detailed guidance.

Expanded, patient-centric Decision Reasons content

This content add-on, which provides consumer-level patient education and decision reason text, is now available for 6 new InterQual and industry content modules. All Decision Reasons content has also been updated to ensure that consumers have more insight into the information that was considered during the decision-making process.

New AI-enabled case stratification solution

Case Intelligence, our newly-released case stratification solution, identifies the likelihood of inpatient admission for a patient and, based on your organization’s customized workflows, recommends appropriate next steps. This enables utilization management teams to efficiently prioritize first and second level reviews, optimize physician advisor time and consistently take action.

Expanded review automation

The InterQual® AutoReview medical review solution has expanded to include 7 additional subsets, covering over 90% of condition-specific Episode Day 1 reviews. This expansion significantly reduces administrative burden, generates time savings and enhances review accuracy and trust by embedding clinical data directly from the EHR.
 

Download our What's New summary for InterQual 2025

See what's new

Sources:
1. Advisory Board. Charted: Outpatient procedure volumes are on the rise. March 17, 2023.
2. Beckmann S, Hula N. Site-of-care shifts: Healthcare’s $50B opportunity. Advisory Board. June 27, 2024.
3. McKinsey & Company. Walking out of the hospital: The continued rise of ambulatory care and how to take advantage of it. September 18, 2020.