CMS will foster an alignment between payors and providers in today’s healthcare environment by extending the use of InterQual content for decision management. Through the agreement, Quality Improvement Organizations, Medicare Fiscal Intermediaries and Medicare Administrative Contractors have access to the spectrum of InterQual Criteria products as well as historical criteria to support their utilization review and quality oversight functions.
CMS departments and Administrative Law Judges can also use the criteria to assist in appeals decisions.
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