Inpatient Initial Review

To expedite the review process, be sure to review our medical necessity criteria expectations for admission, continued stay and discharge.

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. 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.