Start a Medical-Necessity Criteria Training Company (InterQual and MCG)

1. 1

   Anchor the training in how criteria actually work

   InterQual and MCG are not static reference documents, they are living scorecards payer reviewers use during peer-to-peer and continued-stay determinations. Teach clinicians that the criteria evaluate symptom severity, functional status, safety, and support systems, and that the goal is to document a patient's presentation in that language so the claim survives review. That framing is the difference between a checklist course and a course that changes outcomes.

2. 2

   Build role-specific modules

   Different roles use criteria differently: psychiatrists and PMHNPs document determinations, LCSWs tie diagnosis to intervention in treatment plans and progress notes, and utilization-review nurses cite criteria elements when defending admissions and continued stays. Build modules for each so a facility can train its whole medical-necessity team, not just one role.

3. 3

   Respect the proprietary line while teaching fluency

   InterQual and MCG are proprietary criteria sets owned by their vendors, so your training teaches clinicians how to think and document in criteria terms and how to use their facility's licensed criteria, rather than redistributing the proprietary content itself. Be clear about that boundary; it keeps your business clean and credible.

4. 4

   Sell to facilities and to clinicians

   Offer live workshops and cohort training to facilities as staff development, and self-paced or open-enrollment training to individual clinicians who want the skill. Facility contracts are the larger revenue; individual enrollment builds reach and reputation. Price facility training as a project and individual training per seat.

5. 5

   Prove impact with before-and-after evidence

   The strongest sales asset is a facility whose authorization rate rose or whose medical-necessity denials fell after your training. Build assessment into the course so you can show measurable improvement in documentation quality, and use those results to win the next facility.

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Best for: Utilization-review nurses, physician advisors, and clinical educators who know payer criteria deeply and can teach

Not for: Anyone who does not deeply understand InterQual and MCG and behavioral health documentation, or who would redistribute proprietary criteria content; credibility here rests on genuine expertise and respecting the vendors' intellectual property.