To help us share our claims decision-making criteria with you as soon as we make updates, we have added a tool for you to access InterQual® criteria on our website. The Level of Care Criteria Application, also called the InterQual Transparency Tool, on the page is hosted by Change Healthcare.

We use Interqual Criteria for decisions involving:

• medical and behavioral health inpatient levels of care and treatment
• intermediate levels of care such as an intensive outpatient program or Long-term acute care
• outpatient services such as homecare, procedures, outpatient rehabilitation, neuropsychological testing, and wound care treatment.
• We also use InterQual criteria for select surgical procedures including but not limited to spine surgery, hysterectomies, and hip and knee replacement.

Transparency Tool

https://prod.ds.interqual.com/service/connect/transparency?tid=54960ff6-e199-4b42-81ec-cd0dfe0fa64e

How to access the Transparency Tool

1. Once you click on the link above, you will be directed to Optum One Healthcare ID page.
2. For first time users, you will need to register for an account; or you can log in with an existing account.
3. You will be directed to then “Accept Interqual EULA- End User Licensing Agreement”. Click ACCEPT.
4. You will be directed to access the criteria.
5. Choose a subset under product.
   • LOC: Adult
   • LOC: Pediatric
   • LOC: Long Term Acute Care
   • LOC: Inpatient Rehab
   • LOC: Subacute/SNF
   • LOC: Home Care
   • LOC: Outpatient Rehabilitation & Chiropractic
   • BH: Adult and Geriatric Psychiatry
   • BH: Child and Adolescent Psychiatry
   • BH: Substance Use Disorders
   • BH: Behavioral Health Services
   • CP: Procedures
   • CP: Imaging
   • CP: Molecular Diagnostics
   • CP: Durable Medical Equipment
   • Medicare: Behavioral Health
   • Medicare: Imaging
   • Medicare: Molecular Diagnostics & Lab
   • Medicare: Pharmacy
   • Medicare: Post Acute & Durable Medical Equipment
   • Medicare: Procedures
6. Choose a result and begin your medical review.