Viewing Decision Reasons

InterQual® Decision Reasons helps to author consistent communications to members and providers that include clear and specific clinical reasons for decisions regarding medical necessity when making a final non-determination decision.

View Decision Reasons in a decision-tree review

  • Select DECISION REASONS.

    The Decision Reasons content includes a patient education statement that introduces the clinical scenario, including the requested level of care.

  • Select a plus sign Plus sign icon to expand a Decision Reasons section and select a minus sign Minus sign icon to collapse it.
  • When you have finished viewing Decision Reasons, continue with any of the following:
  • Select Change Subset to view criteria for a different subset
  • Select Previous to return to the Subset Overview screen
  • Select Menu to exit the workflow and then, optionally, select an option from the navigation pane

View Decision Reasons in a Q&A review

  • Select DECISION REASONS.

    The Decision Reasons content includes a patient education statement that introduces the clinical scenario.

  • Select a plus sign Plus sign icon to expand a Decision Reasons section and select a minus sign Minus sign icon to collapse it.
  • When you have finished viewing Decision Reasons, continue with any of the following:
  • Select Change Subset to view criteria for a different subset
  • Select Previous to return to the Subset Overview screen
  • Select Menu to exit the workflow and then, optionally, select an option from the navigation pane