Table of Contents
What is the main reason a reviewer would refer a case for secondary review?
Secondary review determines the appropriateness of the current or proposed level of care when it is not supported by criteria on primary review.
What are InterQual rules?
InterQual® criteria are a first-level screening tool to assist in determining if the proposed services are clinically indicated and provided in the appropriate level or whether further evaluation is required. The first-level screening is done by the utilization review nurse.
What is InterQual review manager?
to the InterQual Review Process Review Manager is a browser-based, interactive product that helps automate and streamline the care review process and enables data retrieval and aggregated reporting. Review Manager helps improve consistency among reviewers and supports a more efficient review process.
What does secondary review mean?
A Secondary Data Review (SDR) then, is a research technique used to obtain information to create a clear analytical overview. An analyst undertaking an SDR takes into account multiple pieces of secondary data in order to create a coherent as possible picture on a specific topic.
What is the difference between utilization review and case management?
The key differences between the two models are the integration of utilization management into the role of the case manager versus the separation of the role through the addition of a third team member. Some hospitals have separated out the functions in an attempt to lower overall costs.
How long does secondary review take?
Under Secondary Review means you will be called for an interview. The initial review is to determine if you are qualified for the position you are applying for by reviewing your resume and any assessments you might have taken for the position. It can take up to 6 months to a year to get on.
Why is secondary review important?
Secondary research publications provide a different perspective or an additional analysis of the current literature. This can help identify gaps in the current knowledge in a field and highlight future directions. Secondary research publications include narrative reviews, systematic reviews, or meta-analysis.
What does application under secondary review mean?
Under Secondary Review means you will be called for an interview. The initial review is to determine if you are qualified for the position you are applying for by reviewing your resume and any assessments you might have taken for the position.
What is a secondary review?
What are the InterQual® criteria?
The InterQual ® criteria are used by the utilization review nurses when conducting inpatient and post-acute utilization review. InterQual ® criteria are clinically based on best practice, clinical data and medical literature. The criteria are updated continually and released annually.
How did priority health choose InterQual® level of care (Loc) criteria?
The InterQual ® Level of Care criteria will be reviewed and approved annually by the Associate Vice president of Medical Affairs and the Medical Affairs Committee. Priority Health chose InterQual ® LOC criteria based on requests from providers and because all of our contracted care facilities use InterQual ® LOC criteria.
How can InterQual help with mental health and substance use support?
Support appropriate care by managing your delivery of mental health and substance use care, including initial and concurrent level‐of‐care decisions. Help improve review times and support consistency by integrating third-party content from CMS and other sources into your InterQual workflow.
How can you improve the usability and transparency of InterQual?
Improve usability and transparency by providing multiple InterQual access options to meet any need, from desktop to mobile to cloud. this solution? Explore how InterQual® Procedures Criteria and InterQual® Retrospective Monitoring Criteria supports medical appropriateness and