Creating InterQual® SmartSheets

InterQual® SmartSheets provide a concise format of InterQual Criteria that helps facilitate communication between payers and providers. Using SmartSheets as part of the prior authorization process enables healthcare providers and reviewers to provide the payer with detailed medical documentation and patient information in support of the prior authorization process.

Note: Applies to InterQual® LOC: Outpatient Rehabilitation & Chiropractic Criteria and LOC: Home Care; BH: Behavioral Health Services; CP: Durable Medical Equipment, Imaging, Molecular Diagnostics, Procedures, Specialty Rx Non Oncology, and Specialty Rx Oncology products: Concert Genetics Navigator; and all Medicare Content Navigator products.

Create a SmartSheet

  • Select a subset.

  • Select Smartsheets.

    The SmartSheets screen appears and shows the Results Count, which is the number of services for the selected subset.

  • Optionally, narrow your search for services by entering keywords in the Requested Service field.
  • Select a service under Print Select.
  • Optionally, depending on the options available, change or select the following, if appropriate:
  • Age — select a different age range from the list.
  • Indication — select a specific indication from the list or include all indications by leaving All Indications selected. (Indications are the reason for a requested service.) For example, if your requested service is Appendectomy, then the reason your requesting that service might be Suspected Appendicitis.
  • Depending on the options available, select Open or select Download PDF.

  • Use the controls in the PDF to save and/or print the PDF.

    Note: At any time, you can select Change Subset to return to the Select Subset screen and select a different subset. If you select a different subset, any selections you made in the current subset are cleared. Additionally, you can return to a previous screen by selecting Previous or selecting Menu and selecting an option from the navigation pane. To return to the SmartSheets screen, select SmartSheets. Any selections you made are retained.