Solution

InterQual® Behavioral Health Criteria

Evidence-based clinical decision support for payers and providers who want to make the most appropriate care decisions for mental health and substance use.

 

Get Support
Contact Sales

Evidence-basedcriteria to support behavioral health decisions

Continuum and Q&A formats to provide timeline guidance

Help move patients safely and efficiently through the continuum of care by presenting all settings of care in one view, which incorporates the episode day/week for level-of-care decisions. Intuitive Q&A format simplifies appropriateness decisions for behavioral health services.

Comprehensive content to consider the whole patient

Determine the appropriate level of care or service by factoring in symptoms, comorbidities, functional status, SDoH risk factors, support-system quality, and more. The solution recommends lower levels of care when the patient is improving and more intense settings when the patient’s condition is deteriorating.

Development process to support mental health parity

Help address mental health parity by using InterQual criteria that are developed using the same evidence-based rigor we apply to—and are not more stringent than—our medical/surgical criteria.

InterQual® Evidence-Based Development

Industry content powered by InterQual to drive consistent, efficient reviews

Streamline your medical review process by giving users easy access to The ASAM Criteria® and Medicare policies that have been converted into a structured, interactive tool.

What’s included in InterQual Criteria for Behavioral Health

  • Evidence-based behavioral health criteria

    • InterQual criteria developed using evidence-based rigor and peer review standards 
    • Proprietary benchmarks for Length of Stay and Percent Paid as Observation
    • Care management information notes with InterQual guidelines for expected progress, care facilitation, and admission considerations
    • CMS crosswalk reference
    • Four available modules cover 14 levels of care plus services 

  • Industry content powered by InterQual

    • Industry standard-of-care and regulated-use content seamlessly integrated into your workflow 
    • Content converted into our structured Q&A format to streamline medical reviews
    • Two available behavioral health modules

  • Available modules

    • InterQual Adult and Geriatric Psychiatry
    • InterQual Child and Adolescent Psychiatry
    • InterQual Substance Use Disorder
    • InterQual Behavioral Health Services
    • The ASAM Criteria® Powered by InterQual (exclusive access)
    • Medicare Behavioral Health Powered by InterQual

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

PRODUCT SUPPORT
 

Need support for
this solution?

customerconnection.changehealthcare.com
800.CRITERIA (274-8374)

Get support

Our outcomes

View all insights

On-demand Webinar

Support Behavioral Health Care Decisions in an Age of Parity

On-demand Webinar

Support Behavioral Health Care Decisions in an Age of Parity

Explore how InterQual Behavioral Health Criteria support federal mental health parity requirements, as well as a holistic view of the patient.

Learn More

Article

We Follow the Science—and Defend Against Bias

Article

We Follow the Science—and Defend Against Bias

See how we follow the science where it leads, validating the research we find to uphold the unmatched clinical integrity of the InterQual content.

Learn More

On-demand Webinar

The ASAM Criteria® Powered by InterQual®

On-demand Webinar

The ASAM Criteria® Powered by InterQual®

Discover how The ASAM Criteria® Powered by InterQual® helps increase efficiency and consistency of the utilization-review process while aligning with requirements.

Learn More
Explore related solutions

Let’s start a conversation

We’re here to help you find out how this solution could benefit your organisation. Complete the quick form to the right, and someone will reach out to you soon.

Our experts will:

  • Discuss your individual use case and business needs
  • Explain our features, benefits, and services
  • Show how this solution can help achieve your goals

Want more information? Start here.

Thank You

We appreciate your interest in Change Healthcare. A member of our team will contact you to better understand your needs and discuss potential solutions.

Together, we are accelerating the journey toward improved lives and healthier communities.