Change Healthcare Introduces InterQual® 2020 With COVID-19 Criteria

Latest release includes immediate access to InterQual COVID-19 criteria, further integration of medical conditions with mental health and substance disorders, and addition of AI Natural Language Processing to increase accuracy and automation

NEWTON, Mass.–(BUSINESS WIRE)–#AI–Change Healthcare today unveiled InterQual 2020, the latest edition of the company’s flagship clinical decision support solution. The new release builds on Change Healthcare’s tradition of continuous innovation in content and technology with thousands of updates, including immediate access to InterQual COVID-19 criteria to providers and payers nationwide, and the addition of Change Healthcare AI Natural Language Processing models to further automate medical reviews.

With the COVID-19 pandemic putting unprecedented pressure on all facets of the healthcare system, the need for appropriate utilization is more important than ever. Acute care facilities need to maximize available bed capacity through careful admission screening, continued stay management, and post-acute transition planning. Additionally, patients who do not have COVID-19 benefit from appropriate care transitions, helping to significantly reduce the possibility of exposure.

To support healthcare stakeholders, Change Healthcare is providing immediate access to InterQual criteria related to managing COVID-19 patients to InterQual customers and non-customers. InterQual COVID-19 criteria spans the full continuum of care across content modules including Acute Adult and Pediatric, Long Term Acute Care, Subacute/Skilled Nursing Facility, Home Care, Durable Medical Equipment, and Medicare Durable Medical Equipment Powered by InterQual.

InterQual 2020 also expands the reach of InterQual AutoReview™, its medical review automation solution, which is now enhanced with Natural Language Processing models. With these models, trained by expert physicians, InterQual AutoReview can identify diagnostic information, such as the presence of pneumonia with accuracy as high as 98%, from unstructured clinical narratives. This helps reduce the administrative burden of not only retrieving and reviewing information, but also interpreting narratives.

Among the additional new and enhanced content included in this latest release are the following features:

  • Admission guidance for e-cigarette or vaping product use-associated lung injury (EVALI)
  • New criteria for Medicare Durable Medical Equipment aligned with national and local coverage determinations
  • InterQual Acute Pediatric criteria codified to work with InterQual AutoReview Episode Day 1 reviews for approximately 80% of non-trauma admissions
  • Pediatric Physician Admission Guide, which summarizes the differences in severity and treatment criteria between the Observation and Acute levels of care
  • Further integration of medical conditions with mental health and substance use disorders

“Clinical decision-making and care management have always been challenging, but clinicians today are facing new and highly complex utilization issues,” said Laura Coughlin, RN, vice president of Strategy and Clinical Development with Change Healthcare. “The latest enhancements to InterQual help address many of the pressing clinical issues these teams encounter, and further automate resource-intensive activities. The Change Healthcare Clinical Content team and technologists will continue to evaluate evidence as it becomes available, update criteria as required, and seek new ways to help those who are dedicated to care.”

InterQual 2020 criteria and software enhancements are available immediately on Download Connect, a secure software distribution platform. The new InterQual criteria is also available in all cloud applications immediately, with no installation required. Users can view and evaluate the new criteria now and decide when to make the switch at any time.

To request access to InterQual COVID-19 criteria at no cost, providers and payers can register at

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About Change Healthcare

Change Healthcare (Nasdaq: CHNG) is a leading independent healthcare technology company that provides data and analytics-driven solutions to improve clinical, financial and patient engagement outcomes in the U.S. healthcare system. We are a key catalyst of a value-based healthcare system, accelerating the journey toward improved lives and healthier communities. Learn more at


Kerry Kelly

Vice President

External Communications

Change Healthcare


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