Site of Service: Using the Setting Exception Screening Tool

The Setting Exception Screening tool enables you to capture additional clinical factors that may support a change in setting based on a unique patient scenario. The tool can be used to complete a setting review and gather additional information to inform a secondary review determination when a requested setting does not align with an InterQual or CMS setting.

  • Select the product SOS: Site of Service and then select the Site of Service Setting Exception Screening Tool subset.
  • Read the subset notes to get information about the subset.
  • Select Begin Medical Review button.
  • Answer the questions by reviewing each one as it appears and providing answers by selecting one or more options, as appropriate.
  • Follow rules associated with the questions. Rules display in brackets next to the question (for example, [ ≥ One, except Other clinical information (add comment)] is a rule).
  • If necessary, select Next to continue to the next question. Single answer questions automatically display the next question, while multi-answer questions display the Next button.
  • View any notes associated with the questions by selecting the note icon.
  • Answer all required questions. Required questions appear with the word Required in red text next to the question.
  • When you reach the end of the questions, select View Recommendations button.
  • Select the recommendation. A secondary review icon appears next to the recommendation indicating that secondary review is required.
  • Select Review Summary and continue with Viewing and Printing the Review Summary.