Viewing and printing the Review Summary

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

View and print a decision tree Review Summary

Note: Applies to InterQual® LOC: Acute Adult and Acute Pediatric, LOC: Long Term Acute Care, LOC: Inpatient Rehabilitation, LOC: Subacute and Skilled Nursing; InterQual® BH: Adult and Geriatric Psychiatry, BH: Child and Adolescent Psychiatry, BH: Substance Use Disorders; and InterQual® CP: Retrospective Monitoring and CP: Specialty Referral 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
  • Criteria points you selected as Not Met appear with an X on the Review Summary and in the PDF, and with a dash (–) in the Review Summary Text and XML
  • Reviewer comments you added
  • Benchmarks you selected

  • Decision Reasons you selected for a review that did not satisfy criteria. You copy this information and paste it into your member or provider communication and then replace the text in brackets with the relevant clinical details, as needed.

  • Optionally, customize the Review Summary by selecting or clearing options under Configurations 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 .
  • Selected Criteria in Context (default) — shows criteria you selected (appears with a check mark ) as well as criteria you selected as not met (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 and criteria you selected as not met 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 selected as Not Met.
  • To print the Review Summary, select Print.
  • Depending on the options available, select Open or select Download PDF.
  • The Review Summary PDF includes all review summary details.
  • Use the PDF controls to print and/or save the PDF.
  • Continue with Copying the review results.

View and print a Q&A Review Summary

Note: Applies to InterQual® LOC: Home Care Q & A and LOC and Outpatient Rehabilitation & Chiropractic; InterQual® BH: Behavioral Health Services; InterQual® CP: Durable Medical Equipment, CP: Imaging, CP: Molecular Diagnostics, CP: Procedures, CP: Specialty Rx Non-Oncology, and CP: Specialty Rx Oncology; The ASAM Criteria®1 Navigator; Concert Genetics Navigator; and Medicare Content Navigator products.

  • 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)
  • Tracked recommendations and/or additional criteria selections you made using the InterQual® CriteriaView feature
  • Medical review questions and answers
  • Reviewer comments you added

  • Decision Reasons you selected for a review that did not satisfy criteria. You copy this information and paste it into your member or provider communication and then replace the text in brackets with the relevant clinical details, as needed.

  • Medicare NCD, LCD, and/or Article number associated with the answer selected in the medical review. The value is displayed in the Determination number field. (Available in Medicare Content Navigator 2022 and later.)
  • Home Care Q&A, Private Duty Nursing (PDN) Assessment 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 Configurations:
  • Selected Answers Only — shows only the answer choices you selected.

  • All Answers — (applies to text summary format only) Shows 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, select Print.
  • Depending on the options available, select Open or select Download PDF.
  • Use the PDF controls to print and/or save the PDF.
  • Continue with Copying the review results.