InterQual Review Manager System Administrator s Guide. Change Healthcare LLC Product Support

Transcription

1 InterQual Review Manager 17.0 System Administrator s Guide Change Healthcare LLC Product Support

2 General Terms: Change Healthcare LLC and/or one of its subsidiaries ( Change Healthcare ) is the owner/licensor of the InterQual and InterQual Review Manager products, including the software and clinical content ( Clinical Content ; collectively referred to as the Work ). Change Healthcare has prepared the Work for exclusive use by its licensees of software applications embodying the Clinical Content. The Work contains confidential and trade secret information of Change Healthcare and is provided to licensees who have an existing license agreement in force only under the time-limited license as provided under that license agreement. Licensee and any recipient thereunder shall use the Work in accordance with the terms and conditions of the license agreement. If You Have Been Provided Access for Evaluation Purposes: Change Healthcare is the owner/licensor of the Work. Change Healthcare has prepared the Work for exclusive use by its licensees of software applications embodying the Clinical Content. The Work contains confidential and trade secret information of Change Healthcare and, if you have been provided access to the Work for evaluation purposes only, is provided to you only under a nontransferable, nonexclusive license whose term is limited to the time frame set forth in the notification sent to you containing your access password. You and any recipient hereunder shall use the Clinical Content in accordance with the terms and conditions of this license and the notification. You are granted this license solely for the purpose of your internal evaluation of the Work as part of your decision whether to license the Work, and for no other purpose. You expressly agree to keep the Work confidential and not to release or disclose the Work to any other third person without Change Healthcare's express written permission. Further reproduction, including but not limited to the printing of any portion of the Work or results obtained as part of the permitted evaluation, adaptation, incorporation into other media, and release of the Work by you is strictly prohibited except upon prior written permission of an officer of Change Healthcare. Notwithstanding the foregoing, any copies or reproductions of the Work made by you during the limited evaluation term shall be destroyed and shall not be used for any purpose upon the expiration of the term. Proprietary Notice: The Work is protected under United States and international copyright and other intellectual property laws. If this Work is delivered pursuant to a federal government contract that requires the conveyance of rights in data to the government, it is understood that the Work, including commercial software, clinical content, third-party software, documentation and/or other technical data, was developed exclusively at Change Healthcare s private expense, and that Change Healthcare will convey only limited or restricted rights in the Work to the government consistent with the guidance set forth in the Federal Acquisition Regulation ( FAR ) and/or FAR Supplements. Conveyance of any additional rights beyond limited or restricted rights in the Work requires Change Healthcare s express consent contained in a separate written agreement Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. No portion of this publication may be copied, reproduced, or incorporated into any other media without Change Healthcare s prior written consent. Produced in Cork, Ireland. Acknowledgments and Disclaimer: The Clinical Content is developed by Change Healthcare s clinical research staff which includes physicians, registered nurses, and other healthcare professionals. Many members of Change Healthcare s clinical staff hold advanced degrees and case management certification. The Clinical Content is reviewed and validated by a national panel of clinicians and medical experts, including those in community and academic practice settings, as well as within the managed care industry throughout the United States. The Clinical

3 Content is a synthesis of evidence-based standards of care, current practices, and consensus from licensed specialists and/or primary care physicians. The Clinical Content reflects clinical interpretations and analyses and cannot alone either resolve medical ambiguities of particular situations or provide the sole basis for definitive decisions. The Clinical Content is intended solely for use as screening guidelines with respect to the medical appropriateness of healthcare services and not for final clinical or payment determinations concerning the type or level of medical care provided, or proposed to be provided, to a patient. THE WORK IS PROVIDED AS IS. CHANGE HEALTHCARE DISCLAIMS ANY OTHER WARRANTY, EXPRESS OR IMPLIED, INCLUDING AS TO MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR SERVICE OF THE WORK, OR THE COMPATIBILITY OF OUTPUT USING THE WORK WITH ANY LAW, REGULATION, OR ORDER. IN NO EVENT SHALL CHANGE HEALTHCARE BE LIABLE FOR SPECIAL, INCIDENTAL, CONSEQUENTIAL, OR EXEMPLARY DAMAGES IN CONNECTION WITH, OR ARISING OUT OF, ANY USE OF THE WORK. Trademarks: InterQual is a registered trademark of Change Healthcare LLC and/or one of its subsidiaries. All other trademarks are the property of their respective owners. Patents: The Work may be covered by one or more pending or issued patents, for details visit: Third Party Notices: AMA CPT Codes: The Work may incorporate the CPT terminology developed and copyrighted by the American Medical Association ( AMA ). The CPT codes and terminology are provided pursuant to a license agreement between Change Healthcare and the AMA. CPT copyright 2017 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. U.S. Government Rights The Work includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable, which was developed exclusively at private expense by the American Medical Association, AMA Plaza, 330 North Wabash, Suite 39300, Chicago, Illinois, U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS (b)(2) (November 1995) and/or subject to the restrictions of DFARS (a) (June 1995) and DFARS (a) (June 1995), as applicable, for U.S. Department of Defense procurements and the limited rights restrictions of FAR (December 2007) and/or subject to the restricted rights provisions of FAR (December 2007) and FAR (December 2007), as applicable, and any applicable agency FAR Supplements, for non-department of Defense Federal procurements. BCBSA MPRM: The BCBSA Medical Policy Reference Manual (MPRM) is the proprietary and confidential information of Blue Cross Blue Shield Association Blue Cross Blue Shield Association. All Rights Reserved. The MPRM content is licensed to Change Healthcare.

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5 Contents Welcome to this Guide... 8 What's New in the Administration Module... 9 Contacting Product Support... 9 Accessing the Change Healthcare Customer Hub... 9 Obtaining Product Support... 9 Chapter 1 Managing User Security Before You Begin What Does Review Manager Security Do? What are the Components of Review Manager Security? What are the Types of Review Manager Security? How Does Review Manager Security Work? Setting Up Locations Setting Up Role/Activity Security Setting Up User Security Resetting a User s Password Running Security Reports Chapter 2 Managing Reference Information Searching for an Existing Reference Item Adding Reference Items Maintaining System-Defined Lists Chapter 3 Customizing Your Configurations Maintaining and Migrating Custom Subsets Exporting Subsets for Customization Importing Custom Subsets Deactivating a Custom Subset File Running the Custom Subset History Report Migrating Custom Subsets Managing and Migrating Organizational Policies Writing an Organizational Policy Running Organizational Policy Reports Migrating Organizational Policies Custom Outcome Groups Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 5

6 Generating an Outcome Group Report...55 Cloning and Creating Outcome Groups...56 Cloning an Existing Outcome Group...57 Creating a New Outcome Group...57 Modifying an Existing Outcome Group...58 Customizing Unique Outcome Reasons...59 Assigning Unique Outcome Groups to Products...61 Outcomes and Reasons Supplied by Review Manager...62 Chapter 4 Managing Utilities Configuring Global Settings...68 Optional Field Rules...80 Optional Field Rules: Admission Care Folder/HL7 Account or HL7 Visit...80 Optional Field Rules: Patient...81 Optional Field Rules: Review...81 Assigning Optional Review Fields to Products Viewing and Deleting Criteria Products Setting a Password for your SQL Server Database Managing Length of Stay Data Length of Stay Data Table Information Importing Length of Stay Data Assigning Datasets to Designated Locations Selecting Percentiles of Interest Defining Percentile Values for LOS Data Updating License Information Chapter 5 Managing Report Utilities Overview Setting Report Options General Settings Product-Specific Rules Feature-Specific Rules Maintaining Custom Reports Before You Import a Custom Report Importing a Custom Report Searching For an Existing Custom Report Chapter 6 Managing Audit and Login History Managing Patient Auditing Viewing Patient and Login Auditing Purging Patient and Login Auditing Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 6

7 Chapter 7 Maintaining Letter Templates How Review Manager Organizes Letter Templates Assigning User Security Assigning Global Settings Creating a Letter Template Composing the Letter Template Formatting a Letter Template Adding an Image to the Letter Template Finding an Existing Letter Template Deactivating and Reactivating Letter Templates Chapter 8 Managing Review Transfers Review Transfer Settings Review Transfer Connections Authorization Connections Export Connections Chapter 9 Managing Automated Reviews Managing Automated Reviews Chapter 10 Defining HL7 Configurations Defining HL7 Global Settings Configuring the HL7 Server Setting options using the RmHl7XmlEdit.bat utility HL7 Admission/Auto Routing Messages Setting Rules for HL7 Auto Routing Configuring an Error Notification Viewing Reviews in the Outbound Queues Sending a Manual Outbound Message Viewing and Printing the Reconcile Data Report Chapter 11 Generating DEX Z-Code Identifiers What is a Z-Code? Appendix A Activities and Security Setup Activities Setup Security Setup Sample roles and their associated activities Appendix B Auto Routing Field Mapping About Auto Routing Field Mapping Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 7

8 Welcome to this Guide The InterQual Review Manager System Administrator's Guide explains how to set up and customize behind-the-scenes configurations for the InterQual Review Manager Administration Module, and includes the following options: Managing User Security explains how to set up locations, roles/activity security, and assigned user security. Also, it explains how to reset at user's password. Managing Reference Information explains how to add an item to a reference list, how to add a point of contact to a reference list, and how to maintain a list of categories that help you organize your Review Manager system. Customizing your Configurations explains how to import and migrate custom subsets, create and migrate organizational policies, and create and maintain outcome groups. Managing Utilities explains how to configure global settings; show or hide optional fields for an Admission care folder, patient, and review; view and delete criteria products; and maintain Length of Stay datasets. Managing Report Utilities explains how to set report options for your Review Manager standard and enhanced reports, and how to maintain custom reports. Managing Audit and Login History explains how to view and purge the audit and login detail for Review Manager usage. Maintaining Letter Templates explains how to create templates for letters that will be generated in Review Manager. Managing Review Transfers explains how to set up options used to configure Authorization Request and Review Transfer-related features in Review Manager. Defining HL7 Configurations explains how to set rules to route incoming admissions that come into Review Manager via HL7 and to configure settings for outgoing messages to Hospital Information Systems. Generating DEX Z-Code Identifiers explains how to obtain a list of DEX Z-Code identifiers to use in your InterQual Molecular Diagnostics Criteria reviews. Activities and Security Setup Guide lists all the activities that are pre-defined in Review Manager. Auto Routing Field Mapping describes how information in an incoming HL7 message is mapped to the fields in a Review Manager review. Open Items maintains an accessible list of the items you most recently visited and whose screens you have not closed. Help contains a link to this Help system. Logout enables you to log out of the Administration Module. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 8

9 What's New in the Administration Module Key features introduced into Review Manager 17.0 have resulted in new configurations for the Administration Module. The new settings are described below. Features and Usability Enhancements InterQual Review Manager System Administration Help Structure New Global Setting to disable Initial Review criteria Payment Type has been added as a new System-defined list The InterQual Review Manager System Administrator's Guide has been restructured so that it is now a Help system. A printed copy of the guide appears at the end of the Help s table of contents and on the Home page. Within Clinical Criteria settings, you can now hide Initial Review criteria from appearing in the criteria subset. The Payment Type list allows you to create a customizable list of payment types, such as Medicare and Medicaid, for use on the Work List and the Review Detail screen in Review Manager. Contacting Product Support You can contact Product Support in the following ways: Web customerhub.changehealthcare.com Phone CRITERIA or cesupport@mckesson.com Accessing the Change Healthcare Customer Hub The Customer Hub (customerhub.changehealthcare.com) provides interactive support, answers to commonly asked questions, and links to other resources. For a user ID and password, on the Customer Hub login page, click the Need a User ID and Password? link or contact your Customer Hub site administrator. If you experience difficulty obtaining a User ID and password, contact Product Support. Obtaining Product Support If you experience difficulties using the software that you have licensed, please do the following before you contact Product Support: Consult the online Help and other documentation that accompanies the software to see whether your specific problem is addressed. Consult your internal help desk. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 9

10 If you still cannot resolve your problem, before contacting Product Support, please do the following to assist the Product Support representative in expediting the diagnosis and resolution of your problem: Record the nature of the problem and what you were doing just before the problem occurred. Determine the release number and the build number of the software that you are using. To obtain this information, on the menu bar, click Help and then click the About option. If possible, contact Product Support from in front of your workstation with the relevant application open. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 10

11 Chapter 1 Managing User Security Managing user security in the InterQual Review Manager Administration Module consists of setting up locations, roles and activities, and user security to restrict user activity in InterQual Review Manager. Before You Begin Before logging in to Review Manager, you must configure your Internet Explorer pop-up blocker settings by doing the following: 1. From the Tools menu, select Internet Options. The Internet Options window displays. 2. On the Privacy tab, under the Pop-up Blocker section, click Settings. The Pop-up Blocker Settings window displays. 3. In the Address of Web site to allow text box, type the hostname or IP address of your Review Manager server. For example: If the URL you use to access Review Manager is: then type rmserver. If the URL you use to access Review Manager is: http// /rm/login, then type Click Add, and then close the Pop-up Blocker Settings and Internet Options windows. What Does Review Manager Security Do? Review Manager security is designed to make sure that access to data within the Review Manager application is controlled. It ensures that: Only authorized users have access to specific products and locations. Only authorized users have access to selected Review Manager functionality within certain locations. Only authorized users can perform the activities assigned to them. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 11

12 What are the Components of Review Manager Security? What are the Components of Review Manager Security? Before describing the types of security used in Review Manager in more detail, it may help to first define a list of the components that make up the security process. User A user is anyone who performs tasks in the Review Manager system. Each user is assigned a unique login and password for access to Review Manager. Activity An activity is a task, such as the ability to reset another user s password, that a user can perform in Review Manager. A list of pre-defined Review Manager activities displays in Activities and Security Setup. Role A role is defined by activities and is user-defined. For example, you may want to create a System Administrator role with these activities - the ability to reset another user s password, access to the Administration Module, and the ability to maintain global settings. Location A location is a physical area, such as Massachusetts General Hospital (MGH), where a user can be authorized to perform an activity. For example, a user with the role of Secondary Reviewer may be authorized to conduct a secondary review at MGH but not at Brigham and Women s Hospital. The patient reviewed will be in this location. Product A product refers to an actual InterQual criteria product, such as InterQual Level of Care Criteria, that your company has licensed. For example, a user with the role of Secondary Reviewer may be authorized to conduct a secondary review at MGH for the Level of Care product. What are the Types of Review Manager Security? Review Manager includes built-in security and user-definable security. Built-in security refers to areas of the software that a user cannot control or customize. An example of built-in security is a feature that allows only those users who are authorized to perform a specific activity to have their names appear in a drop-down menu appropriate to that activity. User-definable security refers to aspects of the software that can be customized to control different users who are using the application and is the focus of this topic. Within Review Manager, there are these types of user-definable security: Role/activity security Controls user access to a particular function within Review Manager. For example, if a user is not assigned to a System Administration role or to specific activities that involve System Administration, then that user will not even have access to the System Administration function. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 12

13 How Does Review Manager Security Work? User/role/activity security Controls how users are accessing the Review Manager system by assigning them a role or specific activities for specific products and within specific locations. Therefore, if a user is authorized to perform a secondary review, that person can be assigned secondary reviews, and can conduct secondary reviews. How Does Review Manager Security Work? Review Manager security works by setting up locations, roles, and activities, and then assigning any combination of them to users. Here is more detail about each security setup. Setting up locations In the Administration Module, you set up locations within the Security > Locations selection on the Navigation pane. When you are ready to assign activities to a role or a user, you will see a list of products that your site has licensed and a list of the locations that you set up in the Locations section of Administration Module. Setting up role/activity security In the Administration Module, you set up roles within the Security > Roles selection on the Navigation pane. You can assign individual activities to a user, or you can assign individual activities to a role, and then assign that role to a user. Setting up user/role/activity security In the Administration Module, you set up assigned user security within the Security > Users selection on the Navigation pane. It is in this section that all the user security gets tied together. Products and locations can be assigned to activities, activities can be assigned to users, roles can be assigned to users, and the result is a user who is assigned to specific activities which can only be performed within a certain location(s) and for a certain product(s). Resetting a user s password In the Administration Module, you can modify or reset a user s password. Passwords must be a minimum length of six and maximum length of 20 characters and can be alphanumeric, including special characters (double quotes are excluded). i Note: A red asterisk indicates that entering a value in a field is required. Password requirements are different if Strong Passwords are enabled. Setting Up Locations You set up locations to assign to users in order to restrict where they can perform activities within your site. About Locations When you assign a user to specific locations you use a list that you create through the Locations section of the Administration Module. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 13

14 How Does Review Manager Security Work? i Note: Be sure to create your list of locations first so that you have them ready when performing other tasks in the security process. A location is a physical area, such as Massachusetts General Hospital (MGH), where you can assign security access to your users. If a user is a Secondary Reviewer, for example, and you want that user to be able to perform secondary reviews for patients at MGH, then you should assign that user to the MGH location. Each location that you add to Review Manager is represented by a code and a description of that code. For example, Massachusetts General Hospital can be represented by the code MGH and the description Mass General Hospital - Boston. Locations are structured hierarchically as shown in the diagram below: A location that displays one level above another location or locations is called a parent location to the ones immediately below it (descendants or children). In the above diagram, All Locations is a parent to Location A and Location B, with Locations A and B being descendants to All Locations. Location A is a parent to Building 1, Building 2, and Building 3, with Buildings 1, 2, and 3 being descendants to Location A. When you assign a user to a location, the user is authorized to perform the assigned activity at that location and all locations below it. Therefore, if you assign a user to perform secondary reviews at Location A, then that user can also perform secondary reviews at Building 1, Building 2, and Building 3. If a user is not assigned to a specific location, then that person cannot perform their tasks at that location. For example, if a secondary reviewer is not assigned to Location B, then that user cannot perform secondary reviews there or at any other location below it. You access Location Maintenance by clicking Security > Location Maintenance on the Administration Module Navigation pane. The All Locations option is delivered with Review Manager. You add the other locations. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 14

15 How Does Review Manager Security Work? You can either add a new location, edit an existing location, or move a location. To add a new location You can add a new location to All Locations or to an existing location. 1. Do one of the following: If you want to add a new location to All Locations and it is not already selected, click on All Locations. If you want to add a new location to an existing location, click the plus sign (+) next to All Locations to expand the list. Then, select the location to which you want to add the new location. 2. Click the Add New Location button. 3. Enter a description of the location that you want to add. You can enter a maximum of 30 characters in this required field. 4. Enter an abbreviation for the location. You can enter a maximum of 12 characters in this required field. The Parent Location field is automatically populated with your selection from step 1. The Active box is checked by default. 5. Uncheck the Active box if you want to Inactivate a location. There is no method for deleting a location. All locations remain in the system. However, you can specify whether you want locations to be active for security purposes. 6. Assign length of stay (LOS) regions to the location by using the > button to move a single region or the >> button to move all available LOS regions to the Assigned LOS Regions column. For more information, see Managing Length of Stay Data. 7. Click the Save button to save your entry, or click the Close button to close the screen without saving your entry. The location that you added appears in the list of existing locations the next time you access the list for a search. If the location is active it will appear in the list of locations that you use to assign to a user when you assign activities. To edit an existing location 1. Select Security > Location Maintenance The Location Maintenance screen opens with all the existing locations arranged in a hierarchical tree. If you check the Include Inactive Locations checkbox, then inactive locations will be included in the tree. 2. Select the location you want to edit. 3. Click the Edit Location button. The Edit Location window displays. 4. Modify the location as needed. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 15

16 How Does Review Manager Security Work? 5. Click the Save button to save your changes, or click the Close button to close the window without saving your changes. i Note: If you do not enter any additional locations to the system, All Locations will be the default entry on the Review Detail screen. To move a location to another place on the hierarchical tree 1. From the tree, select the location that you want to move. 2. Click the Move Location button. The Move Location window displays. 3. Select the parent location where you want to move your selected location. 4. The location displays in its new spot on the tree. Setting Up Role/Activity Security In Review Manager, role/activity security enables you to control user access to a function, such as System Administration. About Role/Activity Security You set up role/activity security by assigning activities to roles. A role reflects a job, such as a System Administrator, that is made up of a list of activities that the role is likely to perform, such as resetting a user s password, maintaining global settings, and viewing an audit report. i Note: A list of pre-defined activities comes with Review Manager. The following table shows a sample list of activities and the roles to which these activities can be assigned. Activity Roles System Administrator Reviewer Data Clerk Access the Administration Module View audit report Maintain global settings Maintain location hierarchy Add/edit organizational policy notes Reset another user's password Maintain vendors, facilities, and providers Add/edit roles Maintain offline users X X X X X X X X X Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 16

17 How Does Review Manager Security Work? Activity Roles System Administrator Reviewer Data Clerk View criteria in book form (Book View) X X Assign/reassign a review (limited to reviewers within the same location) X X Conduct a review X X Access the Review Search page View a review (applies to patient overview, worklist, review search and reports) Enable user to select a subset when creating a review Enable user to select a review type when creating a review Add/edit patient data, including user defined fields Create a new review (but can t select criteria unless assigned to the Conduct a Review activity) X X X X X X X X X In the Administration Module, you set up activities within these areas of the Navigation pane: Security > Roles; or Security > Users You can assign individual activities to a user, or you can assign individual activities to a role, and then assign that role to a user. You can either add a new role or search for an existing role. To add a new role 1. Click Security > Roles on the Navigation pane to access the Find Roles screen. 2. Click the Add New Role button. 3. Enter a required description, such as System Administrator, for the role that you want to add. You can enter a maximum of 30 characters in this field. 4. Enter an abbreviation, such as Admin, that represents the role. You can enter a maximum of 12 characters in this field. 5. Check if you want the role status to be considered active. Uncheck it if you want it inactive. There is no method for deleting a role. All roles remain in the system. However, you can specify whether you want roles to be active for security purposes. 6. Check the activities that you want to be associated with the role. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 17

18 How Does Review Manager Security Work? 7. Click the Save button to save your entry, or click the Close button to close the screen without saving your entry. The role that you added will appear in the list of existing roles the next time you access the list with a search. To search for an existing role 1. Click the Find Roles button. A list of all existing roles displays with a description and abbreviation for the role, and the active/inactive status. You can refine your search, so that only a portion of the existing roles appear, by entering a name in the Role Description, or Role Abbreviation, and clicking Find Roles; or by entering a letter and an asterisk if you do not know the full code. For example, you can enter a* (not case sensitive) to access Admin. You can also expand the search by checking the Include Inactive Roles checkbox so that inactive roles are included in your search. i Note: If at any time you want to change the search criteria you ve entered, click the Clear Search Criteria button. i Note: You can re-sort the list by clicking the header on any column. 2. Click the description of the role you want to access. The Edit Role box displays with the record you selected. 3. Modify the role, if needed. 4. Click the Save button to save your changes, or click the Close button to return to the list of existing roles without saving your changes. Setting Up User Security User security controls how those who are performing tasks in Review Manager are accessing the system. About User/Role/Activity Security Users are assigned to a role and/or to activities that are tied to specific products and/or locations. The following diagram shows how the roles, activities, locations, and products are all tied to a user for security assignment. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 18

19 How Does Review Manager Security Work? In this diagram, Ryan Jones has been assigned the role of System Administrator. His role involves performing two activities entering organizational policies and running standard reports. He can enter policies in all locations for all products, but he can only run standard reports in Location A parent location and Location A descendants (Buildings 1 and 2), and just for the Level of Care product. User security has another purpose, and that is to control offline users. An offline user is someone who may take part in the review process, for example, may conduct a secondary review by fax, but does not access Review Manager. Offline users are created the same way as online users (people who can access Review Manager) and they appear on dropdown menus listing users, but they cannot access Review Manager. In the Administration Module, you assign user/role/activity security within the Security > Users selection on the Navigation pane. Once you access the Find Users screen you can enter a user s last name, first name, and user name, and then assign a user to a role, activities to a user, or a user to a role and activities. To create a new user 1. Select Security > Users on the Navigation pane to access the Find Users screen. 2. Click the Add New User button. The User Maintenance dialog box displays. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 19

20 How Does Review Manager Security Work? 3. Complete the fields: Username Enter the name that the user will type when logging into Review Manager. This is a required field. First name Enter the user s first name. Title Enter the user s professional title. Online User Check this box if this person will be using Review Manager. If you do not check the box, this person will be considered an offline user. An offline user is a person who performs reviews using a method other than Review Manager. An example of another method may be printed documentation. Last name Enter the user s last name. This is a required field. Current Password Enter the password that the user will type when logging into Review Manager. Please note that passwords appear encrypted with asterisks when you type them in this field. The password can be assigned by the administrator or obtained from the user. This is a required field. i Note: The existing rule for password creation is that it must be a minimum length of six and maximum length of 20 characters and can be alphanumeric, including special characters (double quotes are excluded). If the Strong password option is enforced, then passwords must be a minimum of eight characters and must include at least one upper-case letter, one lower-case letter, one number, and one special character. Credentials Enter the credentials, such as MD, for a medical reviewer. Active Check whether you want this user status to be considered active. Uncheck if you want it inactive. There is no method for deleting a user. All users remain in the system. However, you can specify whether you want users to be active for security purposes. Session Timeout The value in this field reflects how many minutes a session can run unattended before it times out. A default value of 0 in this field indicates the value will be used from the Global Settings section of this Administration Module. The user may also specify a session timeout. Password Renew Date The value in this field reflects the users password renew date. The value is today s date plus the password renew days value that is set in the Global Settings section of Administration Module. The system administrator may also specify a date. When you enter a new user the field is blank until you click Save. The default Password Renew Days value is 120. When a System Administrator, changes (or resets) a password, Review Manager looks for an entered renewal date. If one is not found, Review Manager looks at the Global Settings table and adds the number of days in the Password Renew Days field to the current date. This date becomes the new renewal date. If a user has passed the renewal date then that person will not be allowed to log in to Review Manager and will be issued an Inactive User message. At this point, only the System Administrator is authorized to change the password. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 20

21 How Does Review Manager Security Work? Force Password Change Check this box to force users to change their passwords during their next login. Users will be prompted for an old and new password and will not be allowed to log into Review Manager until the password is changed. The offline user s name will appear in user dropdown lists, but that person will not have access to Review Manager. Roles and activities Check the roles and/or activities that you want to assign to this user. The selections that you make here determine the functionality to which users will and will not have access. For example, if the System Administrator role (or activities pertaining to a System Administrator) are not checked off for a user, then that user will not even have access to the Administration Module. When you check a role or activity that can be limited by a location or product, the Select the Appropriate Locations and Products dialog box displays. The products that appear on this list are the ones that your company has licensed and installed. The locations that appear are all the active ones that you set up. You must assign at least one location and one product to the selected role or activity or an error message will display. 4. Select a location(s) and product(s) and click OK. The location(s) and product(s) that you selected display next to the associated role or activity on the list. You can change the location(s) and product(s) you selected by clicking the pencil icon that displays next to the role or activity you selected. 5. Click one of the following buttons: Save to save your entry. The user that you added will appear in the list of existing users the next time you access the list with a search. Save and Add New User to save your entry and clear the fields on the Add User window so that you can add another user. Close to close the window without saving your entry. View Security Settings to display the security that you saved for the user. The role(s) and activities assigned to the role will be listed with the location and product assigned to the role. Any user-specific activities for the user will also be displayed. i Note: If you do not select a Location and Product the user will not be able to access the appropriate information. To search for an existing user 1. From the Find Users screen, click the Find Users button. A list of all existing users displays by username, first name, last name and status (active or inactive). Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 21

22 Resetting a User s Password You can refine your search, so that only a portion of the existing users appear, by entering a First Name, Last Name, or Username in the search. You can also enter a portion of a name with an asterisk for example, you can enter sm* (not case sensitive) in the Last Name field to access Smith. Also, you can expand your search by checking the Include Offline Users and the Include Inactive Users checkboxes so that inactive and offline users are included in your search. i Note: If at any time you want to change the search criteria you ve entered, click the Clear Search Criteria button. i Note: You can re-sort the list by clicking the header on any column. 2. Click the first name, last name, or user name, of the user you want to access. The User Maintenance dialog box displays with the record you selected. 3. Modify the record, if needed. To change an existing user s password, see Resetting a User s Password in this chapter. 4. Click one of the following buttons: Save to save your entry. The user that you added will appear in the list of existing users the next time you access the list with a search. Save and Add New User to save your entry and clear the fields on the Edit User window so that you can add another user. Close to close the window without saving your entry. View Security Settings to display the security that you saved for the user. The role(s) and activities assigned to the role will be listed with the location and the product assigned to the role. Any user-specific activities for the user will also be displayed. Resetting a User s Password System Administrators may have instances in which they need to modify or reset an existing user password. The Administration Module provides two ways for resetting passwords: From the Edit User screen From the Password Reset screen To reset a user s password: 1. Choose either A.) or B.) to access the Password Maintenance screen. A. From the Edit User Screen: i. Select Security > Users from the Administration Module navigation pane. The Find Users screen displays, enabling you to search for a user by entering the last name, first name, or user name, and to expand the search by including offline or inactive users. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 22

23 Resetting a User s Password ii. iii. iv. Enter any information that you have about the user that will help to refine your search, and then press Find Users, or just simply press Find Users to access all users. If needed, select Clear Search Criteria to change the search criteria you ve entered. Re-sort the list by clicking the header on any column. Select the user whose password you want to change. The Edit User screen displays. v. Click the Change Password link. The Password Maintenance screen displays. The last name, first name, and username are read-only and populated with the values of the user you selected. vi. Continue with Step 2. B. From the Password Reset Screen: i. Select Security > Password Reset from the Administration Module navigation pane. ii. iii. iv. The Password Reset screen displays, enabling you to search for a user by entering the last name, first name, or username and to expand the search by including offline or inactive users. Enter any information that you have about the user that will help to refine your search, and then press Find Users, or just simply press Find Users to access all users. If needed, select Clear Search Criteria to change the search criteria you ve entered. Re-sort the list by clicking the header on any column. Select the user whose password you want to change. The Password Maintenance screen displays. The last name, first name, and username are read-only and populated with the values of the user you selected. v. Continue with Step Enter the new password once, and then again to confirm it. The existing rule for password creation is that it must be a minimum length of six and maximum length of 20 characters and can be alphanumeric, including special characters (double quotes are excluded). If the Strong password option is enforced from the Global Settings section of the Administration Module, then passwords must be a minimum of eight characters and must include at least one upper-case letter, one lower-case letter, one number, and one special character. 3. Press Save to save the entry, or Close to close the screen without saving your changes and to return to the list of users. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 23

24 Running Security Reports Running Security Reports The Administration Module has two reports that display security configurations for Review Manager users. About Security Reports The two security reports are: User Security report This report shows the password renew date, user status, and roles per user. User Security by Activity report This report is organized by activity and shows the roles, locations, and product groups to which users have access. When you select Security > Security Reports on the Navigation pane, the Security Reports screen displays both reports. In addition, the Security Reports screen displays the report family (which refers to the type of report, such as Facility, Length of Stay, Patient/Review, Payer, Provider, or User), and indications as to whether the report is memorized and public. Filtering a report For both the User Security and User Security by Activity reports you can use a filter option so that your report results display only active users, inactive users, or all users. In addition, the User Security report enables you to filter the report for a specific range of dates for password renewal, and the User Security by Activity report enables you to filter the report so that it displays specific activities. To filter a User Security report: 1. From the Security Reports screen, select the User Security report title. 2. Select a user status. Choices are: Active, Inactive, or All Users. 3. Select a range of Password Renew Dates. Choices are: Specific Date Range Current Calendar Year Current Fiscal Year Previous Fiscal Year Current Quarter Previous Quarter Current Month Previous Month 4. Continue with Generating the Report later in this chapter. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 24

25 Running Security Reports To filter a User Security by Activity report: 1. From the Security Reports screen, select the User Security by Activity report title. 2. From the Filter screen, select a user status. Choices are: Active, Inactive or All Users. 3. Click the Add/Edit button to select activities. 4. From the Select Activity window in the left column, click the binoculars to display all the activities. 5. Select one or more activities from the list, then click the right arrow ( > ) to move your selection to the right column. If you want to select all activities, then click the double arrow ( >> ). The activities that display in the right column will make up your generated report. i Note: To remove an activity, select the activity in the right column and then click the left arrow. To remove all activities, click the double arrows facing left (<<). 6. Click OK. The Select Activity window closes and the list of activities that you selected displays in the Activity field of the Filter screen. 7. If needed, repeat steps 4-6 to select locations and products. you use a Lookup button to select locations and a list to select products. To clear the activities from the Activity field, click the Clear button. Continue with Generating the Report below. Generating a Report You can generate a report after you have set your filters. To generate a report: 1. Click the Results tab. 2. From the Results screen, select an output format. Choices are:.pdf or.rtf..pdf Enables you to save the file in a.pdf format and display the file in the Adobe Reader after you generate it. From the Adobe Reader, you can click the Save a Copy button to save the file to your system..rtf Enables you to export the file to Rich Text Format (RTF). 3. Click the Generate Report button. Memorizing a Report Memorizing enables you to save the filter settings for your report, so that you do not have to configure the settings each time you want to generate the report. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 25

26 Running Security Reports To memorize a report: 1. Click the Memorize tab. Enter a description for the report. This description identifies the report when you want to run it again. 2. If you want the report to be available to all users then click the Public checkbox. 3. Click the Save button. The report displays on the Security Reports list. Deleting a Report You can delete a memorized report. To delete the report: 1. After you generate the report, click the Memorize button and then click the Delete button. For a private report, the following message displays: This will delete the memorized report. Do you wish to continue? For a public report, the following message displays: This is a public memorized report. Are you sure you want to delete the report? 2. Click the Yes button. This message displays: Memorized Report was deleted successfully. 3. Click OK to close the message box. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 26

27 Chapter 2 Information Managing Reference The Reference section in the InterQual Review Manager Administration Module enables you to store and manage reference items, such as employers, facilities, and insurers; and system-defined lists. Searching for an Existing Reference Item To search for an existing reference item: 1. On the Navigation pane, click Reference > and then the category, such as attorney or employer, that you want to access. 2. Click the Find x button (where x equals the category). A list of all items in the category you selected appear. You can enter a portion of a name, or a letter and an asterisk, if you do not know the full item by name. For example, you can enter m* (not case sensitive) in the Description field to access MetroWest Walk-In Clinic. Also, you can expand the search by checking the Include Active checkbox so that inactive items are included in your search. i Note: If at any time you want to change the search criteria you ve entered, click the Clear Search Criteria button. i Note: Note: You can re-sort the list by clicking the header on any column. 3. Click the item that you want to access. 4. Modify the item, if needed. 5. Click the Save button to save your changes, or click the Close button to close the screen without saving your changes. Adding Reference Items Reference items are contacts that appear as drop-down options for fields in Review Manager. For example, you can add a facility called MetroWest Walk-In Clinic, and that facility displays as a drop-down option for the Review Detail - Facility field in Review Manager. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 27

28 Adding Reference Items Before you add a new reference item, search your database to see if the contact has been added previously. You can add and store the following reference items: Attorneys 1. Click Reference > Attorneys on the Navigation pane to access the Find Attorney screen. 2. Click the Add Attorney button. 3. Complete these fields in the Attorney Maintenance screen: Description A description that identifies the attorney or practice. This is a required field. Active The attorney s status in your reference database. Check whether you want this attorney to be active. Uncheck if you want it inactive. Code A unique code assigned to identify the attorney. ID A user-assigned value that identifies an attorney. Primary Contact: Last Name The attorney s last name. This is a required field. First Name The attorney s first name Title The attorney s title. License State The state where the attorney s license to practice is issued. License Number The number of the attorney s license to practice. i Note: Users can enter a description to define a practice or a last name and first name to define an individual attorney. Therefore, neither field can be required. The code can be used internally to identify this attorney/practice. 4. Click the Save button to save your entry, or click the Close button to close the screen without saving your entry. 5. Continue with Adding Point of Contact information. Employers 1. Click Reference > Employers on the Navigation pane to access the Find Employer screen. 2. Click the Add Employer button. 3. Complete these fields in the Employer Maintenance screen: Description A description that identifies the employer. This is a required field. Active The employer s status in your reference database. Check whether you want this employer to be active. Uncheck if you want it inactive. Code A unique code assigned to identify the employer. ID A user-assigned value that identifies an employer. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 28

29 Adding Reference Items Primary Contact: Last Name The employer s last name. This is a required field. First Name The employer s first name. Title The employer s title. i Note: Users can enter a description to define a company or a last name and first name to define an individual employer. Therefore, neither field can be required. The code can be used internally to identify this company/employer. 4. Click the Save button to save your entry, or click the Close button to close the screen without saving your entry. 5. Continue with Adding Point of Contact information. Insurers 1. Click Reference > Insurers on the Navigation pane to access the Find Insurer screen. 2. Click the Add Insurer button. 3. Complete these fields in the Insurers Maintenance screen: Description A description that identifies the insurer. This is a required field. Active The insurer s status in your reference database. Check whether you want this insurer to be active. Uncheck if you want it inactive. Code A unique code assigned to identify the insurer. ID A user-assigned value that identifies an insurer. Primary Contact: Last Name The insurer s last name. This is a required field. First Name The insurer s first name. Title The insurer s title. i Note: Users can enter a description to define an insurer s agency or a last name and first name to define an individual insurer. Therefore neither field can be required. The code can be used internally to identify this insurer/agency. 4. Click the Save button to save your entry, or click the Close button to close the screen without saving your entry. 5. Continue with Adding Point of Contact information. Facilities 1. Click Reference > Facilities on the Navigation pane to access the Find Facilities screen. 2. Click the Add Facility button. 3. Complete these fields in the Facilities Maintenance screen: Facility Description A description that identifies the facility. This is a required field. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 29

30 Adding Reference Items NPI (National Provider Identifier) is a unique identification number for covered healthcare providers. Facility Code A unique code assigned to identify the facility. This is a required field. Tax ID An Employer Identification Number (EIN) is also known as a Federal Tax Identification number and is used to identify a business entity. Active The facility s status in your reference database. Check whether you want this facility to be active. Uncheck if you want it inactive. UPIN The Unique Physician Identification Number identifies physician/nonphysician practitioners enrolled in the Medicare program. Add Insurer Assigned ID In this section, one or more insurer-assigned IDs for the selected facility can be added. Insurer Allows you to select insurers from a dropdown. Names that display on the dropdown list are added in Reference > Insurers section. Insurer Assigned ID An ID value that is assigned by an insurer to the selected facility. A facility can have multiple insurers assigned to it. To add an insurer to a facility, click the Add button. A new row displays enabling you to select another insurer from the dropdown and assign a facility ID to it. i Note: You can only assign one ID to a single insurer. 4. Click the Save button to save your entry, or click the Close button to close the screen without saving your entry. 5. Continue with Adding Point of Contact information. Providers 1. Click Reference > Providers on the Navigation pane to access the Find Provider screen. 2. Click the Add Provider button. 3. Complete these fields in the Provider Maintenance screen: Provider ID A unique identifier for the provider. This is a required field. Active The provider s status in your reference database. Check whether you want this provider to be active. Uncheck if you want it inactive First Name The provider s first name. Last Name The provider s last name. This is a required field. Middle Name The Provider s middle name. Suffix The Provider s suffix. Provider Name The provider s full name. Title The provider s title. License Number The provider s medical license number Specialty The provider s medical specialty, such as Cardiology. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 30

31 Adding Reference Items State of License The state where the provider s medical license is issued. Organization The health maintenance organization with which the provider is affiliated. Tax ID The provider s tax ID number NPI (National Provider Identifier) is a unique identification number for covered healthcare providers. UPIN The Unique Physician Identification Number identifies physician/nonphysician practitioners enrolled in the Medicare program. Add Insurer Assigned ID In this section, one or more insurer-assigned IDs for the selected provider can be added. Insurer Allows you to select insurers from a dropdown. Names that display on the dropdown list are added in Reference > Insurers section. Insurer Assigned ID An ID value that is assigned by an insurer to the selected facility. A provider can have multiple insurers assigned to it. To add an insurer to a provider, click the Add button. A new row displays enabling you to select another insurer from the dropdown and assign a provider ID to it. i Note: You can only assign one ID to a single insurer. To delete a row, click the X to the right of the row that you want to delete. 4. Click the Save button to save your entry, or click the Close button to close the screen without saving your entry. 5. Continue with Adding Point of Contact information. Vendors 1. Click Reference > Vendors on the Navigation pane to access the Find Vendors screen. 2. Click the Add Vendor button. 3. Complete these fields in the Vendor Maintenance screen: Vendor Description A description that identifies the vendor. This is a required field. NPI (National Provider Identifier) is a unique identification number for covered healthcare providers. Vendor Code A unique code assigned to identify the vendor. This is a required field. Active The vendor s status in your reference database. Check whether you want this vendor to be active. Uncheck if you want it inactive. Add Insurer Assigned ID In this section, one or more insurer-assigned IDs for the selected vendor can be added. Insurer Allows you to select insurers from a dropdown. Names that display on the dropdown list are added in Reference > Insurers. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 31

32 Adding Reference Items Insurer Assigned ID An ID value that is assigned by an insurer to the selected vendor. A vendor can have multiple insurers assigned to it. To add an insurer to a vendor, click the Add button. A new row displays enabling you to select another insurer from the dropdown and assign a vendor ID to it. i Note: You can only assign one ID to a single insurer. To delete a row, click the X to the right of the row that you want to delete. 4. Click the Save button to save your entry, or click the Close button to close the screen without saving your entry. 5. Continue with Adding Point of Contact information. Other Contacts 1. Click Reference > Other Contacts on the Navigation pane to access the Find Other Contact screen. 2. Click the Add Other Contact button. 3. Complete these fields in the Other Contact Maintenance section: Description A description that identifies the other contact. This is a required field. Active The other contact s status in your reference database. Check whether you want this contact to be active. Uncheck if you want it inactive. Code A unique code assigned to identify the other contact. ID A user-assigned value that identifies another contact. Primary Contact: Last Name The other contact s last name. This is a required field. First Name The other contact s first name. Title The other contact s title. i Note: Users can enter a description to define a place of business or a last name and first name to define an individual contact. Therefore, neither field can be required. The code can be used internally to identify this contact. This contact is not patient-specific. It is just a contact that cannot fit in the other reference item categories. 4. Click the Save button to save your entry, or click the Close button to close the screen without saving your entry. 5. Continue with Adding Point of Contact information. Points of Contact You can add a point of contact for the reference item. For example, if one of your provider references is Dr. Susan Jones, but you usually speak with the nurse practitioner at her office, then you might want to add the nurse practitioner s number as your point of contact for Dr. Susan Jones. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 32

33 Adding Reference Items Adding point of contact information is the same whether you are adding it for an attorney, employer, insurer, facility, provider, vendor, or other contact. You just need to enter the point of contact screen from the maintenance box where you are adding reference information. i Note: Point of contacts are not attached to a review, therefore you will not be able to access them on dropdown menus on review screens and care folders, and the information is not reportable. To add point of contact information: 1. Go to the maintenance screen for the item you are adding. For example, if you are adding an attorney, go to the Attorney Maintenance screen. 2. Click the Add button on the Points of Contact banner. The Point of Contact Edit dialog box displays. 3. Complete these fields: Description A description that identifies the point of contact. This is a required field. Primary Check this box if this is the primary contact. Specify Individual Person s Name Check this box if you want to identify a specific person by name rather than by description. For example, the description could be Nurse Practitioner, but you can check the box if you want to add the nurse practitioner s name. Do Not Send Check this box if letters should not be sent to this contact. Address Line 1 The first address line for the contact. Address Line 2 The second address line for the contact, if needed. Address Line 3 The third address line for the contact, if needed. City The contact s city. State The contact s state. Zip Code The contact s zip code. County The contact s county. Country The contact s country. Phone # 1 The contact s primary phone number. Phone # 2 The contact s secondary phone number, if needed. Phone #3 The contact s tertiary phone number, if needed. 4. Click the Save button to save your entry or click the Cancel button to close the screen without saving your entry. 5. On the maintenance screen, click the Save button to save your entry, or click the Close button to close the screen without saving your entry. When you save your entry, the name, phone number, and address for the point of contact displays in the Points of Contact section of the Reference Maintenance screen. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 33

34 Maintaining System-Defined Lists In addition to the Add button, the Edit and Delete buttons now appear on the Points of Contact banner. To edit a point of contact entry: 1. Select the point of contact that you want to modify, and then click the Edit button. The maintenance screen for that category opens with the contact you selected. 2. Edit the fields, as necessary. 3. Click the Save button to save the changes, or click the Cancel button to close out of the screen without saving the changes. To delete a point of contact entry: 1. Select the point of contact that you want to delete, and then click the Delete button. This message displays: Are you sure you wish to delete the address? 2. Click Yes if you want to delete the contact, and No if you do not want to delete it. Maintaining System-Defined Lists System-Defined lists are those that are shipped with Review Manager. About maintaining system-defined lists In addition to the system-defined lists, you can add your own values to a list. In order to prevent reference list codes or descriptions from changing after being referenced in a review or care folder, you cannot change values after you initially save them. However, you can re-sort and/or deactivate them. These are the list items that are shipped with Review Manager: List Activity Class Activity Task Activity Type Attendee Type BH Level of Care Body Location DP (Discharge Plan) Followup Reason DP (Discharge Plan) Level of Care DP (Discharge Plan) Referral Reason Functional Area Case Activities Case Activities Case Activities Discharge (Plus Pak Only) BH Reviews Internal Use Discharge (Plus Pak Only) Discharge (Plus Pak Only) Discharge (Plus Pak Only) Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 34

35 Maintaining System-Defined Lists List Denial Type Department Discharge LOC Documentation Sent Via Equipment Type Laboratory Letter Categories LOC Alt Level of Care Payment Type Priority Provider Role Referral Type Services Setting Speciality Functional Area Denials Management (Plus Pak Only) Denials Management (Plus Pak Only) Reviews for Level of Care Products (Excluding ORC) Denials Management (Plus Pak Only) Discharge (Plus Pak Only) InterQual Molecular Diagnostics Criteria Letters LOC Reviews Work List Work List Denials Management (Plus Pak Only) Discharge (Plus Pak Only) InterQual Molecular Diagnostics Criteria Reference > Provider You can access the List Maintenance option by selecting Reference > Lists from the Navigation pane in the Administration Module. To add an item to a list 1. Select a category, such as Priority, from the List Name dropdown. 2. Click the Add button. A blank row displays on the bottom of the list to enter your item. 3. Enter a unique code, such as IDOC and a description, such as Incomplete Documentation. 4. Make the code Active if it isn t already. Active is the default. i Note: Some of the categories, such as Activity Type, have a column for setting a default. 5. To save the item, click Save Changes. To exit without saving the change, click X in the title bar. These lists appear throughout Review Manager. The Customized Reasons list, for example, displays in the dropdown on the Primary Outcome window. To insert an item into a list Select the item above where you want to insert the new item, and then click Insert. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 35

36 Maintaining System-Defined Lists To change the order of the items on a list Select the item you want to move and use the Up and Down buttons. To inactivate an existing list item Click the Inactive radio button next to the item you want to deactivate. The default radio button is disabled. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 36

37 Chapter 3 Customizing Your Configurations The InterQual Review Manager Administration Module allows you to customize many InterQual Review Manager functions so that they are more specific to your organization s needs. You can customize the following features: Custom subsets Created using your content customization tool and can be imported for use in the Review Manager review process for InterQual Ambulatory Care Planning products. Organizational policies Used if your organization makes a decision to override criteria or supplement criteria with additional information. Outcome groups Collections of review outcomes and outcome reasons that reflect a reviewer s decision at each stage of a review and the reason why the reviewer made that decision. Maintaining and Migrating Custom Subsets You can customize clinical content using InterQual Customize. About custom subsets When you license InterQual Customize and any Review Manager product, you can export subsets from Review Manager, customize them in InterQual Customize, and then import the custom subsets back into Review Manager. Custom subsets function in Review Manager with most of the same software features as InterQual criteria. i Note: Using InterQual Customize, if you edit notes in your custom subset, then the citations in the note will not work in Review Manager. If you edit a criteria point (change the rule, assign properties, edit the text, and so forth) in your custom subset, then the re-direction on criteria points will not work in Review Manager. If you do not license InterQual Customize, you cannot create your own custom content, but you can import custom subsets into Review Manager if you license the product associated with the custom subset. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 37

38 Maintaining and Migrating Custom Subsets i Note: In addition, you can use Review Manager to import, export, and migrate custom transition plans, with the same processes used for custom subsets. Custom transition plans are available for LOC: Acute Adult, LOC: Acute Pediatric, LOC: Long- Term Acute Care, LOC: Rehabilitation, and LOC: Subacute/SNF. Exporting Subsets for Customization Before you import a subset into InterQual Customize, you export the subset that you want to customize from Review Manager to a location on your hard drive or network. To export a subset file: 1. From the Administration Module, select Customization > Custom Subsets > Export. 2. From the Export Subset screen, you can access a list of subsets by: Selecting a product and a category, or Entering a keyword(s), or medical code(s), and clicking Find Subsets. 3. Select a subset from the list and click Export Subset at the bottom of the Export Subset screen. 4. Click Save on the File Download box, save the file to a location on your hard drive or network, and then close the dialog box. The subset is saved with a.csfx extension. For more information on importing a subset from your hard drive location to InterQual Customize and customizing the subset, see the Help for InterQual Customize. When you have finished customizing the subset, see Importing Custom Subsets. Importing Custom Subsets After you have customized the subset in InterQual Customize, you can import the custom subset file into Review Manager for use with your other criteria. To import a custom subset file: 1. From the Administration Module, select Customization > Custom Subsets > Import. 2. From the Import Custom Subsets screen, click the Find Custom Subsets button to determine whether the custom subset file you need has already been imported. To refine the search results, you can enter a portion of a name, or a letter, if you do not know the full item by name. In addition, you can refine the search results by selecting a product name from the Product drop-down menu or the version number from the Version drop-down menu. You can expand the search by checking the Include Inactive Custom Subsets checkbox so that inactive items are included in your search. i Note: If at any time you want to change the search criteria you ve entered, click the Clear Search Criteria button. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 38

39 Maintaining and Migrating Custom Subsets The list of imported subsets displays with the custom subset name, product, version, the last time the content was updated, the date and time the subset was imported into Review Manager (Activated), and the status (Active or Deactivated). A history of updates to a custom subset displays, including multiple updates made to an active custom subset within a version year. 3. If you find the custom subset file you need: A. Click the Custom Subset Name to open the subset. You will notice that the background is green to indicate a custom subset. B. To print the subset, click the Print Preview button on the left of the screen. A legal notice displays. Agree to the legal notice by clicking Accept. A document displays in a new window. Click the Print button on that window to print the subset. If you cannot find the custom subset file you need, or if you want to import a new custom subset file: A. From the Import Custom Subsets screen, click the Import Custom Subset button. B. Click Browse to locate the custom subset file (the file will have a.csfx extension), select the desired file, and then click the Import button. The custom subset file that you select may be an update to an existing custom subset, or a new custom subset. A message appears indicating that the system is preparing to import a new custom subset or update an existing custom subset. The message includes the name of the custom subset, the file author, and the date and time that the subset was updated. C. Click Yes to import the subset. Click No if you do not want to import the subset. If you clicked Yes, then this message displays: Custom Subset Import/Update Completed Successfully. 4. Click OK to close the message box. The subset displays on the Find Custom Subsets list. 5. Click the Custom Subset Name to open the subset. Deactivating a Custom Subset File You can deactivate a custom subset from the following locations: Customization > Custom Subsets > Import > Import Custom Subsets screen Customization > Custom Subsets > Maintain > Find Custom Subsets screen Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 39

40 Maintaining and Migrating Custom Subsets To deactivate a custom subset: 1. Find the custom subset that you want to deactivate, and then click Deactivate. This message displays: Deactivation will make this subset unavailable for new reviews. Are you sure you want to continue? 2. Click Yes if you want to deactivate the subset. This message displays: Subset deactivated successfully. 3. Click OK to close the message box. i Note: Once you deactivate a file, the only way to reactivate it is to import it again. To view your custom subset in Review Manager: 1. Log out of the Administration Module, and open Review Manager. 2. Create a new review for a patient. For more information on how to conduct a review, refer to the InterQual Review Manager Help. i Note: You can also view your custom subset in Book View. For more information on how to do so, refer to the InterQual Review Manager Help. When you open the custom subset, it displays with a green background. Running the Custom Subset History Report The Custom Subset History Report enables you to view a history of all updates to a custom subset, including deactivated subsets from current and prior years, for accreditation purposes. Running a Custom Subset History report can consist of the following options: Filtering (or selecting) data for your report Grouping your report by Product and/or Status Running (or generating) the report Memorizing (or saving) filters on the report You can access a screen to filter, group, sort, and memorize the settings of a Custom Subset History Report by selecting Customization > Custom Subsets > Custom Subset Reports from the Navigation pane in the Administration Module and then clicking Custom Subset History. If you have memorized reports, these will be listed too. Filtering Data for your Custom Subset History Report You can filter the Custom Subset History Report to display specific information. Filtering the report is not required. If no filters are entered, all custom subsets will be included on Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 40

41 Maintaining and Migrating Custom Subsets the report. In addition, if you do use filters, you can click the Clear button at any time to clear your settings. You can filter data for your report in one or more of the following ways: To filter by product and subset 1. On the Custom Subset History screen, click the Add button. The Select Product/Subset dialog box displays with a list of licensed products. 2. You can access a list of custom subsets in these ways: Clicking Find Subsets Selecting a product Entering a key word Entering a medical code 3. Select one or multiple subsets and then click OK. The Custom Subset History screen displays with the subsets that you want to filter added. You can click Remove to delete subsets from the filtering list. 4. Click Results if you have finished filtering, otherwise advance to the Status section. To filter by status 1. Select one of these three items: Active Subsets, Deactivated Subsets, or All Subsets. 2. Click Results if you have finished filtering, otherwise advance to the Content Version section. To filter by Content Version 1. Click the Add/Edit button in the Content Version section. 2. Select a version from the left column list. Then use the right arrow button to move your selection from the left to the right column, and click OK. The Custom Subset History screen displays with your selection in the Content Version section. You can click Clear to remove your entry. 3. Click Results if you have finished filtering, otherwise advance to the Author section. To filter by author 1. Click the Add/Edit button of the Author section. Author refers to an organization, not an individual user. 2. Use the binoculars to display authors and select an author from the list. Then use the right arrow button to move your selection from the left to the right column, and click OK. The Custom Subset History screen displays with your selection in the Author section. You can click Clear to remove your entry. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 41

42 Maintaining and Migrating Custom Subsets 3. Click Results if you have finished filtering, otherwise advance to the section to filter by a range of dates. To filter by a range of dates 1. On the bottom of the Custom Subset History screen, select a date range filter, such as Previous Fiscal Year, from the Activated (or Deactivated) Date Between dropdown menu. If you select a pre-determined date range, such as Previous Fiscal Year, then the system will automatically default the date range. If you select a specific date range, then you must add the dates manually, using the calendar icons. 2. After you have finished selecting the filters for your report, click the Results button. Grouping a Custom Subset History Report After you finish filtering the report, you can group it. i Note: Grouping the report is not required. To group the Custom Subset History Report: 1. Click Grouping/Sorting from the Custom Subset History screen. You can group by Product and Status. 2. From the Available column, select the item that you want for your primary group, and then click the right arrow to move that item to the Selected column. 3. Optionally, select the item that you want for your secondary group, and then click the right arrow to move that item to the Selected column. 4. After you have finished selecting the group for your report, click Results to generate the report, or click Memorize if you want to save the filter and group settings you just created. Memorizing the Settings for a Custom Subset History Report 1. Click Memorize from the Custom Subset History screen. 2. Type a description for your report. The name you enter here displays on the Custom Subset History Report screen for you to select again. 3. Check the box if you want the report to be Public, available to other users. 4. Click Save. A message displays indicating that the memorized report was saved successfully. 5. Click OK to close the message box. Generating the Custom Subset History Report 1. Click Results to generate the report. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 42

43 Maintaining and Migrating Custom Subsets A window displays prompting you to select a.pdf or.rtf format. 2. Select your format. 3. Click the Generate Report button. Review Manager runs your Custom Subset History Report according to the filtering rules you specified. Migrating Custom Subsets The Administration Module enables you to migrate custom subsets to the current version. In addition, the Administration Module provides tools for investigating the migration process if it is not successful. Preparing for Migration Before you perform the migration process, read the following information to help make the process run more smoothly. Products: You can only import or migrate subsets that have a like format to the current version. For example, importing or migrating a Nested Decision Tree custom subset for a current version product that is in Q&A format isn t supported. Installation: Upgrade. Perform the installation first. You will then be reminded to migrate. The actual migration must be performed by logging into the Administration Module after the upgrade is complete. Run the Custom Subset History Report: This report displays a history of all updates to custom subsets. Run this report before the migration and then again after the migration. Then you can compare the data in the two reports to determine the success of the migration. If not successful, you can use the discrepancies between the two reports to find your problems. Performing the Migration Process You perform the custom subset migration process on the Migrate Custom Subsets screen. You can access this screen by selecting Customization > Custom Subsets > Migrate from the navigation pane. About migration The Migrate Custom Subsets screen lists all subsets that are eligible for migration. Subsets that are not eligible for migration (Inactive subsets, subsets belonging to products that are no longer licensed, or subsets that have already been imported or migrated) will not populate as available for migration on the Migrate Custom Subsets screen. Also, you may notice that some of the subset names display in red, and some of the checkboxes are disabled. The reason is that these subsets include some invalid categories. Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 43

44 Maintaining and Migrating Custom Subsets To migrate custom subsets: 1. Check individual subsets to select for migration, or use the Select All button to select all subsets in the list. The Clear All button de-selects all selected subsets in the list. 2. Click the Migrate button when you have finished selecting custom subsets. A confirmation message displays with a list of the subsets you selected and prompts you to verify that your selections are correct. 3. Click OK to confirm your selections, or Cancel if you do not want to confirm your selections. 4. If your migration is successful, Review Manager removes the subset from the Migrate Custom Subsets screen and adds it to the Find Subsets screen for the current content version. A message displays indicating that all your subsets migrated successfully. If your migration is unsuccessful, a message displays indicating the subset(s) that failed to migrate. Invalid categories When you are ready to select custom subsets for migration, some of the names may display in red. Custom subsets that display in red have invalid categories associated with them. You can still migrate a custom subset with invalid categories as long as there is at least one valid category associated with it. During migration, the custom subset is associated with the one valid category and the invalid ones are filtered out. In addition, you can select additional valid categories for that subset. You cannot migrate a custom subset with all invalid categories. If this is the case, the selecting checkbox to the left of the subset is disabled. To correct the problem with invalid categories: 1. Click the ellipsis in the Category column to the right of the custom subset name. The list of invalid categories associated with the custom subset display at the top of the window. A list of valid category choices for the custom subset display in the middle of the window. 2. Check the category or categories you want to associate with the custom subset and click OK. The Migrate Custom Subsets screen displays, with the subset name in black and the checkbox enabled for migration selection. 3. Repeat steps 1 and 2 for all other custom subsets on your list that display in red. Investigating Unsuccessful Custom Subset Migrations When you receive a message that indicates that the migration was not successful, run the Custom Subset History report again and compare this report with the one you ran Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 44

45 Maintaining and Migrating Custom Subsets before migration so that you can locate specific problems through the discrepancies in the two reports. In addition, you should consult the CCUMigration.log for a listing of migration successes, failures, and error messages. The default location for the CCUMigration.log file is the Jetty folder. A sample CCUMigration.log displays below. The CCU Migration log contains a list of all the custom subsets that went through the migration process whether or not the migration was successful. The screenshot that displays below shows the log report for the migration of the Below Knee Prosthetics: Senior (Custom) - McK subset. An interpretation of the lines in the log report for the Below Knee Prosthetics: Senior (Custom) - McK subset follows: Line 1 Fri Dec 19 11:23:38 EST 2014 Starting subset migration This line displays the date and time that the migration for this one subset started. Line 2 Fri Dec 19 11:23:38 EST 2014 Migrating subset Below Knee Prosthetics: Senior (Custom) - McK, subset_cid - A130DF45FCF4D32352E DF5057 Change Healthcare LLC and/or one of its subsidiaries. All rights reserved. 45