With InterQual Connect™, payers can easily automate all authorization requests, even those requiring medical review, within their existing systems. Providers receive quicker authorization approvals for most requests and payers only need to touch the exceptions that can’t be approved automatically—no more duplicative medical reviews or wasting precious staff time on routine authorizations. - InterQual Medical Review & Authorization: InterQual Connect is a flexible SaaS solution, integrated into payer and provider health information systems. It pairs the leading InterQual® Criteria, now available as a web service, with proven and secure connectivity. - A Unique Solution: The only integrated solution to enable full auto authorization, including medical review. - Uses Existing IT Infrastructure: No new hardware, software or IT staff required. - Easy to Implement: Time to value can be as little as 60 days when using a certified Change Healthcare Alliance Partner. - Provides Fast, Secure Connectivity: Uses the proven authorization gateway. - Keeps Users in Existing Workflows: Providers submit an authorization request, and payers receive the request and medical review from within their current UM/CM workflow. - Delivers Real-time InterQual Access: Just-in-time content from our cloud platform helps ensure you get the latest version, but you can choose when to make the switch. - Aligns with InterQual Hospitals: Payers benefit from the shared clinical language with thousands of InterQual hospitals plus a direct connection to those hospitals already on the InterQual Connect cloud. - Supports Payer/Provider Collaboration: Helps reduce the costs and hassle of prior authorization, while providing full transparency of payer criteria to providers. - Medical Review Service: Optimized for integration, this web service delivers seamless access to the InterQual medical review within your UM/CM system or payer’s provider portal. You get the same leading evidence-based InterQual Criteria combined with our modern, user-friendly interface. The SaaS platform helps you reduce your IT burden, providing realtime access to content. You receive software and content upgrades automatically without waiting for installation and validation, but still maintain control of when to switch to the newer content. You also gain the freedom to make the Medical Review Service available throughout a networked system, such as a multi-hospital and outpatient network or multi-location payer. The Medical Review Service works with any modern browser. - Secure Authorization Connectivity: Our cloud platform and authorization gateway enable the creation of a secure network of connected payers and providers by providing a common language, standard API protocols, access controls and routing rules. Providers transmit an authorization request, complete with an InterQual medical review, through the gateway directly to a payer. The payer system then applies business rules and the InterQual Criteria to this request, and instantly delivers the authorization status back through the gateway to the provider. The gateway has been deployed as part of our cloud solutions, and currently supports thousands of authorization transactions per week between connected payers and providers. It is optimized for our interoperable (XML) medical review format, and can also support the HIPAA X12 278 transaction standards.

Change Healthcare is inspiring a better healthcare system. We are a leading independent healthcare company that provides data and analytics-driven solutions to improve clinical, financial and patient engagement outcomes in the U.S. healthcare system. Our comprehensive suite of software, analytics, technology-enabled services and network solutions take costs out of the healthcare system by driving improved results in the complex workflows of payers and providers by enhancing clinical decision-making and simplifying billing, collection and payment processes, and enabling a better patient experience. We are creating a stronger and more efficient healthcare system that enables better patient care, choice, and outcomes at scale.

Prior Authorizations Accelerated by AI and Automation

Our cloud-based, AI-powered prior authorization software provides a complete patient access solution for healthcare providers by leveraging the latest machine learning, artificial intelligence and automation technology with exception handling by our experienced billing specialists.

Requests requiring a prior authorization are initiated electronically to the appropriate payer. Complex requests and exceptions are handled by our team of certified specialists to provide you with complete coverage of your prior authorization claim.

Status notifications are communicated in real-time through automated follow-ups by robotic process automation (RPA). Our RPA bots repeatedly check requests under review for status change updates.

We provide you with complete coverage of your prior authorization requests with a 98+% accuracy and 99.5% adherence to turnaround times. No more auth requests getting kicked back to you due to lack of information. We take care of it for you.

Provider Integration

Submit and update your prior authorization requests directly from your local EHR/EMR using either an API or HL7 based bi-directional integration.

Authorization Determination Engine

Determine if your request requires a prior authorization using the Authorization Determination Engine, built using machine learning.

Unified Workflow Experience

Perform all prior authorization related functions on a unified web portal, built to offer you an intuitive and seamless experience.

Automated Authorization Follow-up

Keep up with the status of an initiated prior authorization claim using automated authorization follow-up.

Analytics and Reporting

Obtain full transparency into your prior authorization process using detailed and robust analytics and reporting.

Alerts and Notifications

Receive constant alerts and notifications pertaining your prior authorization claim, which includes all updates and payer communications