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Complete a case review

Physician advisors and clinical leadership use the unified Case Reviews worklist to work utilization (UM), physician-advisor (MD advisor), and clinical documentation (CDI) cases — reviewing queries, weighing documentation suggestions, and recording a physician determination.

Before you start​

You need a physician-advisor tier role (Physician Advisor, Clinical Director, or CMO own this area; Chief and CMO see parts of it in view-only mode). In the left navigation, open the Physician Advisor group and click Case Reviews.

Steps​

  1. Click Case Reviews under Physician Advisor in the left navigation. The live worklist opens, combining UM, MD-advisor, and CDI cases in one place.
  2. Filter the list by status and priority to find the cases assigned to you, and expand a row to see the admission criteria summary without leaving the list.
  3. Click a case to open the full review workspace for that case.
  4. Work the case in the review workspace:
    • Review open queries and respond as needed.
    • Work through documentation suggestions, accepting or dismissing each one.
    • Attach supporting documents or create a referral where the case calls for it.
  5. Record your physician determination for the case. Your name is attached to the determination automatically.
  6. Click Back to worklist to return to the queue and pick up the next case.

Tips / Troubleshooting​

  • The worklist tabs and in-case actions are role-gated: if a queue (for example, CDI) or an action is missing, your role doesn't include it.
  • If your session expires you are returned to the sign-in page; sign in again and reopen the worklist.
  • The Physician Advisor group also holds Decision Trees, Coverage, Patient Plan Review, and Timeline for related review work.