Guideline for using criteria that is specific to each criteria product, provides an overview of criteria concepts and components, review steps, practical tips and information on supporting materials
What is the Review Process?
100
Any review that is conducted after the primary review, and is done by the Medical Directors
What is the Secondary Review?
100
These can be used in the search field to select the subset needed
What are Medical Codes?
100
Should only use if there is not a diagnosis specific subset and would include Medical, Trauma, Surgical, and Nursery
What are General Subsets?
100
Includes subsets for Medically Complex, Respiratory Complex, Ventilator Weaning and Wound/Skin
What is LTACH?
200
Explains the changes made to the criteria when there is an update
What are the Clinical Revisions?
200
Explains when to use a subset, can include common symptoms and information about a clinical condition
What are Subset Notes?
200
This is the category that should be used for both Adult and Pediatric
What is Procedures?
200
Users can find preeclampsia in this subset
What is Hypertensive Disorders of Pregnancy?
200
Includes subsets for Burns, CNS/TBI, Medically Intensive, Orthopedic/Amputation and spinal Cord Injury
What is Rehabilitation?
300
List names and classes of medications
What is the Drug List?
300
Explains criteria points, specific instructions on how to apply criteria, or gives definitions of medical terminology
What are Criteria Notes?
300
This lists all codes related to a procedure, what specific procedure are included and the setting for each
What is the Subset Criteria/Overview?
300
These subsets can be used for those <= 28 days old
What are Nursery and hyperbilirubinemia?
300
Includes Levels 1-3 and Pediatric Subacute
What is Subacute/SNF?
400
Identifies what acronyms and symbols represent
What is the Abbreviations and Symbols List?
400
Clinical statements that refer to test results, medications, symptoms, findings, monitoring, medical management, functional status, or prescribed therapies
What are Criteria Points?
400
This list all of the procedure options within a Medical Review (You should always check the one that was requested)
What is the Recommendations List?
400
These include Observation, Acute, Intermediate and Critical
What is Level of Care?
400
Requires at least 4 hours of nursing care and skilled therapy 2-3 hours per day at least 5 days a week
What is Level III (Complex Care)?
500
This button leads the user to all documents
What is the InterQual Clinical Reference?
500
These specify how many of the next-level criteria are required
What are Criteria Rules?
500
This notes indicates that there is not enough research, the balance of benefit and harms is not clear, the evidence of quality is mixed or new technology is being investigated for a procedure. This requires a Secondary Review
What is Limited Evidence?
500
Any three specific subsets that are for <18, but not for >=18
What are Bronchiolitis, Cellulitis, Croup, Failure to Thrive, Gastroenteritis, Hyperbilirubinemia, Meningitis, Nursery or Pyelonephritis