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Change Healthcare InterQual Connect Guidelines for Pega Care Management (PCM)

Easily Integrate with Industry Leading Medical Necessity guidelines.

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Seamless integration between Pega Care Management and the Change Healthcare InterQual®* solution provides clients with access to industry-leading, evidence-based medical necessity guidelines. With this connectivity, the review summary of guidelines generated by the InterQual review are maintained within the workflow and stored in the patient record as a basis for approving authorization requests along with real-time, bidirectional interactions with the InterQual Medical Review Service SaaS solution.

InterQual is a registered trademark of Change Healthcare, LLC and/or one of its subsidiaries

Key Features

  • Access evidence-based guidelines through real-time, bidirectional interactions with the InterQual Medical Review Service SaaS solution
  • Review Utilization Management guidelines within the workflow
  • Manage authorization requests, admissions, initial and concurrent review, and discharge planning
  • Integration ruleset for easy integration
  • App Studio Configuration page for client specific integration points


Installation Guide




Compatible with

Pega Platform 8.7 Pega Care Management 8.7

Product Owner

Chip Warburton

Last updated

January 24, 2024

Product Capability

Data Integration App Studio Installation and Deployment
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