Add InterQual Connect™ clinical criteria
When configured by your administrator, the Clinical Criteria button opens the Change Healthcare InterQual Connect™ application to add clinical criteria to authorization requests.
Note: Do not use browsers in private mode (also called incognito) when using InterQual Connect™ in TruCare ProAuth. It does not work in browsers using private mode.1. In the Authorization Details screen, select Clinical Criteria.
Information from the prescreen fields is passed to the InterQual® system to identify a guideline that is appropriate for those field values. The next steps depend on the results of this guideline search.
• If no guidelines are found, and a Clinical Review BRE rule is configured for it, an error message informs you that no clinical criteria guidelines were identified for the authorization request and to contact the administrator to correct the issue. You can skip the rest of these steps and continue the authorization request workflow.
• If a single guideline is identified, InterQual® opens directly to the appropriate guideline for the authorization request. You can skip the next step.
• If multiple guidelines apply, the Select Guideline for Clinical Criteria dialog opens. Complete the next step.
2. Select a guideline.
You are connected to the InterQual Connect™ application.
3. Select Medical Review to add clinical criteria.
The Medical Review window opens.
4. Provide required criteria.
For information about using the InterQual Connect™ application, select Help in the application.
While you are completing the clinical criteria, you can select Save Review to save the information for later. The status of the review displays near the top of the page. To complete the clinical review, select Clinical Criteria on the Authorization Details page.
5. Select Complete to complete the clinical criteria.
A warning informs you that completing the medical review will lock it from further edits. If you need to return to the review to make changes or check it, select No. Otherwise, continue to the next step.
6. If your review is complete, select Yes.
Clinical criteria are linked to the authorization in TruCare when you complete the request and submit it.
After completing clinical criteria, going back to the Prescreen page and changing values might invalidate the clinical criteria. When you select Next on prescreen, you will see the following message: "A clinical criteria submission is either in progress or completed and will be discarded. Would you like to proceed?"
• Selecting Yes discards the clinical review and you may need to provide clinical criteria again as you navigate through the authorization workflow. For the IP Comprehensive workflow, you may see a clinical review message on the Review page for one or more IP procedures due to an edit made. Click the Edit form on the IP procedure to get to the IP procedure details page.
• Selecting No keeps the clinical criteria. You can change the field values back to their original values and continue.