GuidingCare tips: InterQual SmartSheets and messages

Processing your authorization requests in a timely manner is important to us, to help ensure our members – your patients – get the care they need when they need it.

With this in mind, here are a few tips to help you use our GuidingCare authorizations tool more effectively.

Download InterQual® Smartsheets

When InterQual criteria review pops up during your authorization request, you have the opportunity to download a Smartsheet. These PDFs list the questions we’ll ask during the InterQual criteria review, specific to your authorization request.

To access our InterQual Smartsheets guide:

  1. Log into your prism account
  2. Click Authorizations then Request an auth
  3. Click Auth request tool help
  4. Click GuidingCare resources

Reduce the chance of review delays

Depending on your authorization request, our clinicians may need to review the information you’ve submitted to make a determination. To ensure this process moves as quickly and smoothly as possible, we strongly recommend you:

  • Attach recent clinical documentation that matches InterQual criteria, including imaging and lab reports. If no documents are available or the documents don't match the criteria, it delays our review process which then delays your response time.
  • Avoid free text during the InterQual review process

Check your GuidingCare messages

When we need to communicate with you about your authorization request, including when we need additional information to complete our review, we send messages through GuidingCare.

To check your GuidingCare messages:

  1. Log into your prism account
  2. Click Authorizations then Request an auth to access GuidingCare
  3. In the navigation menu on the left side of your screen, click the Messages icon.
  4. Click the Auth ID number to be taken to the screen where you can respond with notes and attachments.

Tips for using GuidingCare messages:

  • Make sure your authorization request is attached to the correct facility ID. GuidingCare sends messages about an authorization request to anyone connected to the requesting facility. If the request isn’t attached to the correct facility ID, you won’t receive our messages.
  • Check for messages, even if it doesn’t look like you have any. Often, when you have a new message, you’ll see a red indicator over your Messages icon in the navigation menu. However, if someone else connected to your facility recently checked a message you also received, your red indicator will go away. Be sure to check your messages often.
  • Double check attachment parameters. Hover your mouse over “Add attachments” to see GuidingCare’s file size limits and accepted file types