Notes and Symbols

Associated with an indication, criteria point, medical-review question, or recommendation, informational notes provide reminders of the best medical practice, new clinical knowledge, procedural information, explanations of criteria rationale, and current literature references.

Indicate that quality indicator data exists for this condition. If you select a criteria point that has a Quality Indicator note, Change Healthcare recommends that you complete a quality indicator checklist.

Often indicate that the patient might be at a higher risk for readmission and could benefit from comprehensive discharge planning. If you select a criteria point that has a Transition Plan note, Change Healthcare recommends that you complete a transition plan.

Associated with an indication, criteria point, medical-review question, or recommendation, these are mandatory notes that provide important information that you must read while conducting a review.

Associated with a criteria point, Care Management notes provide information that helps to drive quality care and ensure that the patient is progressing along the continuum of care.

Provides instructions for the Two-Midnight rule.

Associated with a recommendation, it indicates that a secondary medical review is required.

Indicates that selecting these criteria will not result in the criteria being met.

Associated with a criteria point, it indicates an urgent circumstance and does not require pre-authorization.

Associated with a recommendation, it indicates that the recommendation is designated as limited evidence in this clinical scenario.

Indicates that no reviewer comments are associated with a criteria point or medical review question.

Indicates that reviewer comments are associated with a criteria point or medical review question.