InterQual 2022 Revolutionizes Clinical Decision Support with AI-Powered Insights and Streamlined Workflows

Change Healthcare has unveiled InterQual 2022, a comprehensive upgrade to its flagship clinical decision support platform that combines the latest evidence-based criteria with cutting-edge technology to reshape how healthcare organizations manage utilization decisions. The new release marks a significant evolution in supporting providers and health plans with objective, independently peer-reviewed clinical guidelines while introducing powerful automation capabilities.

Evidence-Based Criteria Meet Real-World Healthcare Challenges

At its core, InterQual 2022 expands the scope of clinical guidance across multiple specialties. The platform now incorporates the newest American College of Cardiology and American Heart Association standards for chest pain management, addressing one of the most common emergency presentations. Beyond cardiology, the update introduces an exclusive partnership with the American Society of Addiction Medicine (ASAM), resulting in a dedicated content module that brings specialized addiction medicine criteria directly into the decision support workflow.

Healthcare organizations managing behavioral health populations gain additional capabilities through enhanced transition planning tools and social determinants of health (SDOH) assessment frameworks. These additions recognize that clinical decision support extends beyond diagnosis codes to encompass the broader context of patient care.

Automation and Workflow Intelligence Reshape Authorization Processes

InterQual 2022 introduces several workflow optimizations designed to reduce administrative friction. The new InterQual Decision Reasons functionality enables organizations to communicate clinical rationale consistently and transparently to patients, explaining why certain services may not meet appropriateness criteria. This transparency supports both patient understanding and defensible utilization management.

A notable advancement is the electronic review-sharing capability, which allows providers to transmit InterQual reviews directly to payers, effectively eliminating manual authorization back-and-forth. For organizations managing outpatient rehabilitation and chiropractic cases, restructured criteria simplify the submission process and accelerate approval timelines. Additionally, Medicare-focused users benefit from auto-selection functionality that automatically identifies the appropriate national or local coverage determinations based on service date and location, reducing configuration workload.

Predictive Analytics Transforms Case Management

Perhaps the most transformative feature is the integration of artificial intelligence into InterQual AutoReview. The new predictive models analyze patient data to forecast the probability of observation versus inpatient admission and predict length-of-stay requirements. This capability enables case managers to proactively identify high-priority cases requiring immediate intervention, facilitating timely care coordination and earlier discharge planning.

By combining predictive analytics with evidence-based criteria and medical review automation, organizations can build utilization management programs that are simultaneously more efficient, data-driven, and clinically defensible.

Cloud-Based Accessibility and Immediate Deployment

InterQual 2022 deploys exclusively through cloud-based applications, eliminating installation requirements and ensuring that all users gain immediate access to updated criteria upon release. This architecture removes IT barriers and democratizes access to the latest clinical evidence across distributed organizations.

Heather Pigott, senior director of utilization management at Driscoll Health Plan, highlighted the platform’s practical impact: “Our teams find InterQual user-friendly, and with it being cloud-based, new releases are instantly accessible with no IT lift. We look forward to what InterQual 2022 has to offer with its expanded and updated criteria and technology-enabled, simplified processes.”

The Strategic Vision Behind the Release

Laura Coughlin, vice president of clinical innovation and development at Change Healthcare, emphasized the guiding philosophy: “As with every InterQual release, we are committed to following the science and maintaining the utmost clinical integrity. The technology enhancements we’ve added build upon the foundation of objective evidence to drive efficiencies, payer-provider connectivity, and improved outcomes.”

This release reflects a broader healthcare trend: organizations seeking to balance the need for operational efficiency with the imperative to maintain rigorous clinical standards. InterQual 2022 addresses this balance by layering advanced AI capabilities onto a foundation of independently peer-reviewed clinical evidence, ensuring that automation enhances rather than compromises clinical decision-making.