ResourcesBehavioral ResourcesClinical Practice ToolsClinical Review GuidesInpatient Initial Review
Inpatient Initial Review
To expedite the review process, be sure to review our medical necessity criteria expectations for admission, continued stay and discharge.
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. In some instances, initial authorizations occur via our fast-certification process, which may result in a shorter initial review.
DSM Diagnosis Information
- Include any Clinical Disorders, Personality Disorders, Intellectual Disability, or General Medical Conditions
Presentation
- Initial presentation
Risk History
- Identify any suicidality or homicidality in concerns to: prior attempts, medical/legal, consequences, or family history.
- Explain details of risk of harm, both past and present
- Has a crisis intervention occurred recently
Stressors
- Identify any recent and current stressors.
Mental Health/Substance Use Treatment History
- List any previous and current Mental Health Treatment and practitioners
- List any previous and current Substance Treatment and practitioners
Substance Use
- What are the substances used?
- What are the amounts, frequency, and the duration of use?
- When were the substances last used?
- Are there any current withdrawal symptoms?
- Inquiries made into current vital signs and lab results.
Family Mental Health and Substance Use History
- Identify any family mental health or substance use history.
Current Medication
- Medications: Types, dosage, frequency, titration plan and who prescribing provider
- Additional comments and/or concerns about medication use.
- Any additional comments concerning medication.
Medical History
Identify relevant medical history.
Family / Social Supports
- Identify family and social supports.
Treatment Plan
- Identify treatment goals, interventions, and time lines.
- Discharge planning information; identify any barriers to possible follow-up.
Discharge Plan
- Outline discharge plan in regards to follow-up, support needs, and relapse concerns.
- Please provide the discharge information during last review or if no further authorization is needed, you may leave the information on the designated staff’s voicemail.