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For imaging solutions, please visit us at Change Healthcare Enterprise Imaging.
Scheduled
We are pleased to announce that the InterQual 2025 March content release is now available for InterQual® Cloud Solution customers.
This content release includes updates to the following modules:
• InterQual® Acute Adult Criteria
• InterQual® Acute Pediatric Criteria
• InterQual® Long-Term Acute Care Criteria
• InterQual® Inpatient Rehabilitation Criteria
• InterQual® Subacute and Skilled Nursing Criteria
• InterQual® Home Care Criteria
• InterQual® Outpatient Rehabilitation and Chiropractic Criteria
• InterQual® Adult and Geriatric Psychiatry Criteria
• InterQual® Child and Adolescent Psychiatry Criteria
• InterQual® Substance Use Disorders Criteria
• InterQual® Behavioral Health Services Criteria
• InterQual® Durable Medical Equipment Criteria
• InterQual® Imaging Criteria
• InterQual® Molecular Diagnostics Criteria
• InterQual® Procedures Criteria
• InterQual® Specialty Rx Non Oncology Criteria
• InterQual® Specialty Rx Oncology Criteria
• InterQual® Specialty Referral Criteria
• InterQual® Retrospective Monitoring Criteria
• The ASAM Criteria® Navigator
• Concert Genetics Navigator
• Medicare Behavioral Health Navigator
• Medicare Imaging Navigator
• Medicare Molecular Diagnostics and Lab Navigator
• Medicare Pharmacy Navigator
• Medicare Post-Acute and Durable Medical Equipment Navigator
• Medicare Procedures Navigator
• InterQual® Coordinated Care
For clinical revisions and additional details about this release, go to the What’s New page on the InterQual® Resource Center and then select InterQual Content.
InterQual® Cloud Solutions updates
If your organization has configured your environment to disable new criteria releases by default, you will need to log in to the Administration module and enable the criteria when you are ready to start using it.
InterQual® Review Manager and InterQual® View
The InterQual 2025 content release is the final content release supported by both InterQual Review Manager and InterQual View.
The content update package file with release notes and upgrade instructions will be available April 4, 2025, on Download Connect. For customers using InterQual Review Manager in a Change Healthcare-hosted environment, updates will begin April 4, 2025, 8:00 p.m. ET.
Multiple options have been established to help Review Manager and InterQual View customers migrate to alternative InterQual software solutions before the InterQual 2026 content release. Contact your account manager or Product Support to learn more about these options.
InterQual® Community
The new InterQual Community is now available! As a Community member you will:
• Have access to InterQual clinical documentation and resources.
• Have access to active discussion forums with Optum product experts and fellow customers.
• Find and connect with your peers by product and role.
The InterQual® Resource Center is being retired. Register now for the InterQual Community to stay connected and informed, and to ensure you don’t lose access to vital documentation and resources.
You should have already received an email from donotreply@optum.com with the subject line: “Complete Your Registration to Access Optum Enterprise Customer Community”. This email will include your unique registration link. Click the link to complete your setup using your One Healthcare ID (OHID). Note: the unique registration link will be active for a limited time, so please access the link to complete registration immediately upon receipt.
If you do not receive a unique registration link, or if it has expired, you can self-register by following the directions posted here.
Don’t have an OHID yet?
No problem! You can create one now at One Healthcare ID or follow the instructions in the registration invitation.
New enhancements
Decision Reasons
Decision Reasons content for the Medicare Post Acute and Durable Medical Equipment (DME) Navigator, Medicare Behavioral Health Navigator, and Behavioral Health Services modules is now available. Decision Reasons helps primary and secondary reviewers, case managers, medical directors, and others to author consistent communications to members, patients, and providers that include clear and specific clinical reasons for decisions regarding medical necessity. Decision Reasons content is available in InterQual® Cloud Solutions only and only if the organization licenses this content add-on module. For more information about licensing Decision Reasons content, contact your Account Manager.
Site of Service
To allow for a more data-driven and patient-specific approach to determining the appropriate setting of a service, InterQual Acute Adult Criteria, InterQual Acute Pediatric Criteria, InterQual Behavioral Health Services Criteria, and InterQual Procedures Criteria were updated to include a benchmark setting provided at the CPT® code level. The setting, based on the selection of a CPT code, will appear on the InterQual® Review Summary to support clear communication of both the medical review and setting outcomes, and to improve organizational workflow.
Contact information
For any additional information or assistance, log in to the Customer Care Hub and submit a new case to Product Support. Product Support is also available by email at interqualsupport@optum.com and by phone at 1-800-CRITERIA (274-8374).
REF 16959663
This content release includes updates to the following modules:
• InterQual® Acute Adult Criteria
• InterQual® Acute Pediatric Criteria
• InterQual® Long-Term Acute Care Criteria
• InterQual® Inpatient Rehabilitation Criteria
• InterQual® Subacute and Skilled Nursing Criteria
• InterQual® Home Care Criteria
• InterQual® Outpatient Rehabilitation and Chiropractic Criteria
• InterQual® Adult and Geriatric Psychiatry Criteria
• InterQual® Child and Adolescent Psychiatry Criteria
• InterQual® Substance Use Disorders Criteria
• InterQual® Behavioral Health Services Criteria
• InterQual® Durable Medical Equipment Criteria
• InterQual® Imaging Criteria
• InterQual® Molecular Diagnostics Criteria
• InterQual® Procedures Criteria
• InterQual® Specialty Rx Non Oncology Criteria
• InterQual® Specialty Rx Oncology Criteria
• InterQual® Specialty Referral Criteria
• InterQual® Retrospective Monitoring Criteria
• The ASAM Criteria® Navigator
• Concert Genetics Navigator
• Medicare Behavioral Health Navigator
• Medicare Imaging Navigator
• Medicare Molecular Diagnostics and Lab Navigator
• Medicare Pharmacy Navigator
• Medicare Post-Acute and Durable Medical Equipment Navigator
• Medicare Procedures Navigator
• InterQual® Coordinated Care
For clinical revisions and additional details about this release, go to the What’s New page on the InterQual® Resource Center and then select InterQual Content.
InterQual® Cloud Solutions updates
If your organization has configured your environment to disable new criteria releases by default, you will need to log in to the Administration module and enable the criteria when you are ready to start using it.
InterQual® Review Manager and InterQual® View
The InterQual 2025 content release is the final content release supported by both InterQual Review Manager and InterQual View.
The content update package file with release notes and upgrade instructions will be available April 4, 2025, on Download Connect. For customers using InterQual Review Manager in a Change Healthcare-hosted environment, updates will begin April 4, 2025, 8:00 p.m. ET.
Multiple options have been established to help Review Manager and InterQual View customers migrate to alternative InterQual software solutions before the InterQual 2026 content release. Contact your account manager or Product Support to learn more about these options.
InterQual® Community
The new InterQual Community is now available! As a Community member you will:
• Have access to InterQual clinical documentation and resources.
• Have access to active discussion forums with Optum product experts and fellow customers.
• Find and connect with your peers by product and role.
The InterQual® Resource Center is being retired. Register now for the InterQual Community to stay connected and informed, and to ensure you don’t lose access to vital documentation and resources.
You should have already received an email from donotreply@optum.com with the subject line: “Complete Your Registration to Access Optum Enterprise Customer Community”. This email will include your unique registration link. Click the link to complete your setup using your One Healthcare ID (OHID). Note: the unique registration link will be active for a limited time, so please access the link to complete registration immediately upon receipt.
If you do not receive a unique registration link, or if it has expired, you can self-register by following the directions posted here.
Don’t have an OHID yet?
No problem! You can create one now at One Healthcare ID or follow the instructions in the registration invitation.
New enhancements
Decision Reasons
Decision Reasons content for the Medicare Post Acute and Durable Medical Equipment (DME) Navigator, Medicare Behavioral Health Navigator, and Behavioral Health Services modules is now available. Decision Reasons helps primary and secondary reviewers, case managers, medical directors, and others to author consistent communications to members, patients, and providers that include clear and specific clinical reasons for decisions regarding medical necessity. Decision Reasons content is available in InterQual® Cloud Solutions only and only if the organization licenses this content add-on module. For more information about licensing Decision Reasons content, contact your Account Manager.
Site of Service
To allow for a more data-driven and patient-specific approach to determining the appropriate setting of a service, InterQual Acute Adult Criteria, InterQual Acute Pediatric Criteria, InterQual Behavioral Health Services Criteria, and InterQual Procedures Criteria were updated to include a benchmark setting provided at the CPT® code level. The setting, based on the selection of a CPT code, will appear on the InterQual® Review Summary to support clear communication of both the medical review and setting outcomes, and to improve organizational workflow.
Contact information
For any additional information or assistance, log in to the Customer Care Hub and submit a new case to Product Support. Product Support is also available by email at interqualsupport@optum.com and by phone at 1-800-CRITERIA (274-8374).
REF 16959663
This scheduled maintenance affects: Clinical Decision Support (InterQual® Cloud Solutions, InterQual® Coordinated Care, InterQual® Criteria, InterQual® Review Manager – Hosted, InterQual® Review Manager – Installed).