I apologize for not being more informative. I work for an insurance company that has way too many cases. Here is what is happening: To save time the director over the UM department is advising staff members to not run interqual for requests, but to "just wing it". On the documentation that is sent to the department of insurance and to our providers the denials state that Interqual criteria was used, when in fact is was not.
This directive was hush hush, and I found a few of these when I was reviewing cases for medication compliance. I asked around a few individualss said they didn't like the idea, but did it anyway.
I want to challenge it because its unethical, but I need something to back my case up.