Viewing and Printing the Review Summary

The Review Summary includes information about the medical review and the criteria you selected.

ⓘ  Note: Applies to InterQual® Level of Care (except Home Care Q & A and Outpatient Rehabilitation & Chiropractic), InterQual® Behavioral Health (except Behavioral Health Services), and InterQual® Ambulatory Care Planning Specialty Referral and Retrospective Monitoring products.

  • View the review summary details, which may include information such as:
  • Reviewer name and date/time information
  • Criteria product, subset, and version
  • Criteria you selected appear with a check mark Check mark
  • Criteria points you explicitly selected as not met appear with an X on the Review Summary screen and PDF, and with a dash (–) in the Review Summary text and xml
  • Reviewer comments you added
  • Benchmarks you selected
  • InterQual® Decision Reasons you selected for a review that did not meet criteria. You copy this information and paste it into your member, patient, or provider communication and then replace the text in brackets with the relevant clinical details, as needed. Note that you cannot edit the information in the Review Summary.

  • Optionally, customize the Review Summary by selecting or clearing options in the Settings menu.

    The following options apply to information on the Review Summary screen, PDF, and in the Review Summary Text or XML.

  • Selected Criteria Only—Shows only criteria you selected. Selected criteria appear with a check mark Check mark.
  • Selected Criteria in Context (Default)—Shows criteria you selected (appears with a check mark Check mark) as well as criteria you explicitly indicated does not satisfy criteria (appears with an X). It also shows the unselected sibling criteria points.

  • All Criteria—Shows the entire subset and criteria for all episode days. Criteria you selected appear with a check mark Check mark and criteria you explicitly indicated does not satisfy criteria appear with an X.

  • In addition to the above options, you can select one or more of the following options:

  • Hide Criteria Status PDF Only—Hides the criteria status in the Review Summary PDF.
  • Include Notes PDF Only—Shows the InterQual notes in the Review Summary PDF .
  • Hide Criteria Selected as Not Met—Hides criteria points you explicitly selected as not met.
  • To print the Review Summary, click Print button.
  • Depending on the options available, click Open or click Download PDF button.
  • The Review Summary PDF includes all of the review summary details.
  • Use the PDF controls to print and/or save the PDF.
  • Continue with Copying the Review Results.

ⓘ  Note: Applies to InterQual®Level of Care: Home Care Q & A and Outpatient Rehabilitation & Chiropractic; InterQual®Ambulatory Care Planning: Procedures, Imaging, Specialty Rx Oncology, Specialty Rx Non-Oncology, Molecular Diagnostics, and Durable Medical Equipment products; The ASAM Criteria® Navigator1; Concert Genetics Navigator; and Medicare Content Navigator products.

1The ASAM Criteria is a registered trademark of the American Society of Addiction Medicine. 

  • View the review summary details, which may include information such as:
  • Reviewer name and date/time information
  • Criteria product, subset, and version
  • Criteria Status
  • Available and selected recommendations
  • Selected medical codes (for example, ICD, CPT®, and HCPCS codes)
  • If the InterQual® CriteriaView feature is available, any tracked recommendations and/or additional criteria selections
  • Medical review questions and answers
  • Reviewer comments you added
  • Decision Reasons you selected for a review that did not meet criteria (applies to Care Planning Durable Medical Equipment and Procedures Criteria). You copy this information and paste it into your member, patient, or provider communication and then replace the text in brackets with the relevant clinical details, as needed. Note that you cannot edit the information on the Review Summary screen.
  • Medicare NCD, LCD, and/or Article number associated with the answer selected in the medical review is displayed in the Determination number field (Available for InterQual 2022 content and later)
  • Home Care Q&A, Private Duty Nursing (PDN) Assessment includes a suggested maximum number of private duty nursing hours per day and week. It also shows the points for each answer choice and the sum of points based on the selected answer choices.
  • Optionally, customize the Review Summary by selecting or clearing the options under Settings:
  • Selected Answers Only—Shows only the answer choices you selected.

  • All Answers Applies to text summary format onlyShows all answer choices for the questions.

    In addition to one of the above options, you can optionally select one or more of the following options:

  • Include CriteriaView Selections PDF Only—(Available with the Q&A CriteriaView feature) Shows any recommendations you selected to track on the CriteriaView pane and/or any additional criteria selections you made. The option is selected by default and available only if you tracked recommendations and/or made additional criteria selections. If you don't want to include this information, clear the check box.
  • Hide Criteria Status PDF only—Hides the criteria status in the Review Summary PDF.
  • Include Notes PDF only—Shows InterQual notes in the Review Summary PDF.
  • To print the Review Summary PDF, click Print button.
  • Depending on the options available, click Open or click Download PDF button.
  • Use the PDF controls to print and/or save the PDF.
  • Continue with Copying the Review Results.