Using InterQual® Decision Reasons

ⓘ  Note: InterQual Decision Reasons is an optional feature that can be activated only by contacting Change Healthcare's Services or Product Support team.

InterQual Decision Reasons helps primary and secondary reviewers, case managers, medical directors, and others to author consistent communications to members, patients, and providers that include clear and specific clinical reasons for decisions regarding medical necessity.

Decision Reasons is available for select, frequently used subsets within the following InterQual® products: Acute Adult, Acute Pediatric, Inpatient Rehabilitation, Long Term Acute Care, Subacute & Skilled Nursing, Durable Medical Equipment, and Procedures.

Watch the Tutorial icon

You access Decision Reasons from the Medical Review screen or the Book View screen.

ⓘ  Note: Access from the Book View screen is view-only.

  1. Click DECISION REASONS.

    The Decision Reasons content includes a patient education statement that introduces the clinical scenario, including why the patient was admitted and, if appropriate, alternate levels of care at which care could have been delivered.

  2. Click a plus sign Plus sign icon to expand a Decision Reasons section and click a minus sign Minus sign icon to collapse it.

  3. Click a Decision Reason to select it. Selected Decision Reasons change to green and have a check mark.

    ⓘ  Note: Selecting a top-level Decision Reason will also select the children. Alternatively, you can select each Decision Reason individually.

  4. When you have finished selecting Decision Reasons, click MEDICAL REVIEW COMPLETED.
  5. Continue with Viewing and Printing the Review Summary where you view and copy the selected Decision Reasons information and paste it into your member, patient, or provider communication.