As a provider working with managed care patients, you are asked to participate in a clinic review process. In order to expedite the review process, be sure to review applicable medical necessity criteria expectations for admission, continued stay and discharge. Please note, the information asked in a review can vary depending on the level of care requested as well the diagnosis of the patient. Below are the various outlines Evernorth care managers could utilize during the review process.

Inpatient Review Outline

• Inpatient Initial Review Outline

Inpatient Concurrent Review Outlines

• Child and Adolescent Higher Level of Care
• Eating Disorder Higher Level of Care
• General Higher Level of Care
• Substance Use Higher Level of Care

Intensive Outpatient Concurrent Outlines

• Eating Disorder Intensive Outpatient Concurrent Review Outline
• Intensive Outpatient
• Substance Use Intensive Outpatient

Outpatient Review Outlines

• Outpatient Treatment Review Outlines

ABA Review Outline

• Applied Behavior Analysis Review Outline