What they don’t tell the providers who use their products - is they escalate as much as they can for medical review due to their escalation list and even if it meets IQ criteria - well we know what happens than. InterQual Auth Accelerator pairs Optum’s InterQual clinical criteria with AI to digitize payer rules, extract relevant clinical information from provider records and bring it to human reviewers. Most payers using the accelerator are starting with an augmented workflow, where AI organizes and presents information but a human reviewer still makes the determination, rather than fully automated approvals.
“We do not and will not automate denials,” Dr. Kontor said. “This is only accelerating reviews and automating approvals.”