Create an authorization request for medical care for a patient with coronary heart disease (CPT: 33519) to test the connector. Access the Review Manager to review the medical criteria for approval of the request.
- Log in to Pega Integration Solution for Change Healthcare InterQual by entering the CareManagerRM operator and the password that you specified.
- On the header, click New > Create Authorization Request Case to start an authorization request.
- In the Metadata step, in the Authorization type field, select Inpatient, and then click Continue
- Select the following items and click Continue after you complete
- Service provider or select the Use Requesting provider check box.
- In the Enter detail request step, enter the information, and then click Continue.
- In the Review authorization step, review the information, and then click
The system creates a new authorization request and routes it to the ServiceReview@MyHealthPlan workbasket.
- Click the hyperlink to access the guidelines.Users with the appropriate assignment privileges can access the pended authorization from the work queue.
- Click Invoke Guidelines next to the selected service. On the Invoke Guidelines screen, the Review Manager presents the appropriate subsets from its product suite, based on the procedure code that was passed.
- Select one subset, enter the details, and then click Next.
- When you are finished, click Save in the top right corner.
- Once the transaction appears, click Submit. The ID appears. This completes the successful validation of the connector.