Selecting a review outcome and using InterQual® Decision Reasons

After you evaluate criteria, depending on your workflow, you can select a review outcome to reflect your decision on the review and, if appropriate, use InterQual® Decision Reasons.

Selecting a review outcome

Note: If you need this functionality as part of your workflow and it's not available, contact the InterQual Services or Product Support team.

After you evaluate criteria, depending on your workflow, you can select an outcome and reason to reflect your decision on the review and communicate why you made that decision.

In a primary review, if you select an outcome that requires a secondary review (for example, Referred for Secondary), you should save (rather than complete) the review when you finish the review workflow. Completing the review locks it from further edits and prevents a secondary reviewer from recording a secondary outcome. Alternatively, saving the review locks the primary outcome and prevents selection of a different subset, but allows a secondary reviewer to make any necessary changes to the criteria selections and record a secondary outcome. Also, note that only a primary reviewer has the option to select an outcome that refers a review for secondary review. A secondary reviewer cannot refer a review for further evaluation.

For a primary review

  • Select REVIEW OUTCOME.
  • Select the following, as appropriate:
  • Service date
  • Review type
  • Primary outcome
  • Outcome reason

Note: You can clear your selections from any of the fields by clicking the x next to your selection.

  • Optionally, enter a comment in the Comments box to provide additional information about the outcome. Select Add Comment to save your comment.
  • Select REVIEW SUMMARY and continue with Viewing and printing the Review Summary.

For a secondary review

  • Select REVIEW OUTCOME.
  • From the Secondary Outcome list, select an outcome.
  • From the Outcome Reason list, select a reason.
  • Optionally, enter a comment in the Comments box to provide additional information about the outcome. Select Add Comment to save your comment.
  • Select REVIEW SUMMARY and continue with Viewing and printing the Review Summary.

Using InterQual Decision Reasons

If your workflow includes selecting a review outcome, you can select decision reasons on the Review Outcome screen.

  • Select REVIEW OUTCOME.
  • Scroll to the Decision Reasons section.
  • Select a plus sign to expand a section of the Decision Reasons and select a minus sign to collapse it.
  • Select a Decision Reason. 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.