Sharing and retrieving InterQual^® reviews

Review Share is a feature that enables providers to electronically share InterQual reviews with another InterQual user. Once a review is shared by a provider, it can then be electronically accessed and retrieved by a payer (or by a provider using a payer’s provider portal) by initiating a new review for a member with matching name and date of birth.

The Review Share feature does not provide a notice of admission or authorization request to the payer. Providers should follow their usual payer notification process in addition to sharing the review through the Review Share feature.

Share a review

From the warning message that appears as you complete a review

Note: If selecting a review outcome is part of your workflow, the review outcome is not included in a shared review.

Follow your organization's workflow to conduct a review and then share the review:

• Select COMPLETE when you have finished conducting the review.

  A warning message telling you the review will be locked from further edits appears.

• Select Share this review (additional information may be required on the next screen) and then select COMPLETE REVIEW.

  The Review Share dialog appears.

• Select an organization from the drop-down list.
• Complete any additional required fields that appear, such as Member ID and Case ID.

• Select SHARE.

  A message indicating the organization you shared the review with appears.

• Select CLOSE or wait until the message closes automatically.

  The shared review can now be accessed and retrieved by a payer, or by a provider using a payer’s provider portal, when they initiate a new review for a member with matching name and date of birth.

View Review Share History

After you share a review, you can optionally view the Review Share History for details about when and with whom the review was shared.

• Open a completed review that has been shared and go to the Review Summary.
• View the Review Share History in one of the following ways:
• View the Review Share History on the Review Summary. See Viewing and Printing the Review Summary for more information.

• Select REVIEW SHARE. The Review Share dialog appears and shows the Review Share History. Close the Review Share dialog box when you are done.

  Note: If you inadvertently share a review with the wrong payer, enter an incorrect member ID, or share a review you didn’t want to share, you can stop sharing it. See Revoke a shared review for details.

From the Review Summary after a review is completed

Note: If selecting a review outcome is part of your workflow, the review outcome information is not included in a shared review.

Open a completed review and then share the review:

• Go to the Review Summary and select REVIEW SHARE.

  The Review Share dialog appears.

• Select an organization from the list.
• Complete any additional required fields that appear.

• Select SHARE.

  An informational message appears.

• Select CLOSE or wait until the message automatically closes.

  The review can be accessed and retrieved by a payer (or by a provider using a payer’s provider portal) when they initiate a new review for a member with matching name and date of birth.

Revoke a shared review

If you inadvertently share a review with the wrong payer, enter an incorrect member ID, or share a review you didn’t want to share, you can revoke it. Revoking a shared review stops sharing it; however, keep in mind that the review may have been accessed and retrieved by the recipient before you revoked it.

Open a completed review that has been shared.

• Go to the Review Summary and select REVIEW SHARE .

  The Review Share dialog appears.

• Under Review Share History, select REVOKE and then select REVOKE again in the warning message to confirm you want to stop sharing the review.

• If you need to share the review again, follow the directions for sharing a review from the Review Summary.

Retrieve a shared review

Shared reviews can be accessed by the payer when initiating an InterQual review for the same member. Additionally, a provider can access their own shared review from a payer’s authorization portal if it requires a review to be submitted and review sharing has been enabled by the payer. This enables InterQual providers to include a shared review with an authorization request without having to duplicate the review.

When you initiate a new InterQual medical review for a member, InterQual searches for any shared reviews based on an exact match of the member's the first name, last name, and date of birth.

• Start a new review.

  If shared reviews are found, they'll appear in the InterQual^® Shared Reviews dialog box.

• Select SELECT to open the shared review. A read-only version of the review opens. Nested Decision Tree reviews open on the Medical Review screen and Q&A reviews open on the Review Summary screen.
• Select RETRIEVE REVIEW to save a copy of the shared review to your organization's system.

Note: After you retrieve a shared review, it will not appear in the InterQual Shared Reviews dialog box the next time you create a review for the member.