Medical necessity criteria

Below is a general outline that our care managers will follow when reviewing; however depending on the specifics, the care manager may ask for additional information. Please note, if the plan requires authorization for this level of care, an Intensive Outpatient Program Request Form will need to be submitted.

DSM Diagnosis Information

• Include any Clinical Disorders, Personality Disorders, Intellectual Disability, or General Medical Conditions

Clinical Presentation

• Medications: Name, dosage, frequency, start date, and end date and prescriber
• Identify the Primary Care Physician and care coordination between practitioners
• Current eating disorder symptoms (include frequency and duration)
• Height, weight, labs, vitals

Treatment Goals and Progress

• Identify treatment goals, interventions, measurable outcomes
• Outline progress and identify plan to overcome barriers
• List clients verbalization of identified treatment goals

Support System

• Identify supports: Work, home, friends, church, community resources, and legal resources
• List the date of the last family/support session and its outcome
• If no family/support session has occurred, when is on planned?

Aftercare Planning Information

• Identify provider(s): Name, phone number, credentials, and follow-up appointment details
• Identify utilization of community resources
• Identify barriers to discharge