Concurrent review

Determining level of care and coverage

[Copy] We may evaluate your patient’s care while the person is in the hospital or undergoing outpatient treatment. Our goal is to help make sure the person gets the right level of care at the right time. And at a reasonable cost. A concurrent review also determines if the person’s plan covers the treatment under review.

The concurrent review process includes:

• Collecting information from the care team about the person’s condition and progress
• Determining coverage based on this information
• Informing everyone involved in the patient’s care about the coverage determination
• Identifying a discharge and continuing care plan early in the stay
• Assessing this plan during the stay
• Identifying and referring potential quality of care concerns and patient safety events for additional review
• Identifying people for referral to our covered specialty care programs, such as case management and disease management, behavioral health, the National Medical Execellence Program®, women's health programs such as the Beginning Right® Maternity Program and the infertility program.

Concurrent review may be done by phone, fax or on-site at the facility.