⚡ Utilization Review Software

Utilization Review Software Built for
Behavioral Health Providers

CriteriaIQ is the only utilization review software purpose-built for behavioral health and addiction treatment facilities using Kipu EMR. It reads live patient charts and automates clinical authorization documentation across every major framework — ASAM, Milliman MCG, InterQual, and LOCUS — in under 60 seconds.

Start 14-Day Free Trial See All Features
The problem

UR clinicians spend
3–4 hours daily
on documentation

The average utilization review clinician in a behavioral health setting spends 45–90 minutes per authorization request — digging through clinical notes, cross-referencing criteria frameworks, writing individualized justifications, and filling out insurance forms manually.

Multiply that across 5–10 daily authorizations and you're looking at half a workday lost to documentation that could be automated.

⏱
45-90 minutes
per authorization request, on average
📋
5-10 frameworks
to know and apply correctly per insurer
🔄
Manual re-entry
of data already documented in Kipu
❌
Denials from
generic non-individualized documentation
The solution

What CriteriaIQ automates

Every documentation task your UR team does manually, every day.

⚕
ASAM 4th Edition

All 12 subdimensional risk ratings, ASAM 3.7/3.5 auth probability scores with explicit rubrics, dimensional treatment plans, and one-click appeal letters.

Learn more →
🧠
Milliman MCG

SI/IS domain scoring, MCG auth probability with point-by-point breakdown, concurrent review progress tracking, and MCG-specific appeal letters.

Learn more →
📋
InterQual BH

InterQual primary criteria + NYS additional criteria per InterQual BH Criteria. Specific lettered sub-criteria cited. Concurrent review timeline awareness.

Learn more →
📊
LOCUS Assessment

All 7 dimensions scored against the official 4th Edition sheet. LOC 4 coverage evaluation (23-27), composite score bar, phone review script.

Learn more →
✍
Appeal Letters

Formal appeal letters citing only the correct framework. Never mixes ASAM with MCG or InterQual. Structured for peer-to-peer review with evidence citations.

Learn more →
How it works

From chart to authorization in 3 steps

01
🏥
Open any Kipu patient chart

Navigate to a patient in Kipu EMR as you normally would. CriteriaIQ detects Kipu automatically and shows in your Chrome toolbar. No separate login, no copy-pasting.

02
⚕
Click your analysis framework

Choose ASAM, MCG, InterQual, LOCUS, or IOP form. CriteriaIQ scrapes clinical documents, assessment scores, medications, and diagnoses — then sends everything to AI in one request.

03
📄
Review, edit, export, submit

A complete, individualized clinical analysis appears in the overlay panel. Review auth probability, generate an appeal letter, export a print-ready PDF, and submit. Done.

FAQ

Utilization review software questions

What is utilization review in behavioral health?
+
Utilization review (UR) in behavioral health is the clinical process of evaluating whether a patient's requested or ongoing level of care meets the criteria required by their insurance plan for authorization. UR clinicians review patient charts, apply criteria frameworks (ASAM, MCG, InterQual, LOCUS), and submit clinical documentation to justify medical necessity.
Does CriteriaIQ work with any version of Kipu EMR?
+
Yes — CriteriaIQ works as a Chrome browser extension and activates automatically whenever you navigate to any Kipu EMR patient chart. No Kipu API access or IT configuration is required.
What makes CriteriaIQ different from generic AI writing tools?
+
CriteriaIQ is purpose-built for clinical authorization. It knows ASAM subdimension scoring, MCG SI/IS criteria, InterQual domains, LOCUS 4th Edition scoring sheets, and specific insurer policies like InterQual BH InterQual BH. Generic AI tools produce documentation that doesn't cite the right criteria, use correct terminology, or meet insurer-specific requirements.
Is patient data stored when I use CriteriaIQ?
+
No. On the Enterprise plan, the Anthropic API key lives on CriteriaIQ's server — not in your browser. Scraped patient data is processed in-memory and never stored server-side. A Business Associate Agreement (BAA) is included with Enterprise plans.
How long does it take to get a full ASAM analysis?
+
Under 60 seconds from clicking the button to a complete analysis with all 12 subdimensional risk ratings, ASAM 3.7 and 3.5 authorization probability scores, dimensional treatment plans, and a full clinical summary.
Can CriteriaIQ help with insurance appeal letters?
+
Yes — CriteriaIQ generates formal appeal letters that cite only the correct framework criteria. ASAM appeals cite only ASAM 4th Edition language; MCG appeals cite only Milliman Care Guidelines; InterQual appeals cite InterQual BH domains and InterQual BH Criteria criteria. Frameworks are never mixed.

Ready to cut your UR documentation time in half?

14-day free trial. No credit card. Works on your existing Kipu account.

Start Free Trial See Pricing