Concurrent Review
An ongoing payer evaluation of medical necessity conducted during an active course of behavioral health treatment, typically at regular intervals during inpatient or residential care.
Full Definition
Concurrent review (also called continued stay review) is a form of utilization management in which the insurance payer periodically assesses whether the client continues to meet medical necessity criteria for the current level of care. Clinical staff submit updated documentation—including current symptoms, treatment response, and discharge barriers—to support continued authorization. In editorial work on behavioral health documents, concurrent review notes must be distinguished from prior authorization requests (which occur before services begin) and retrospective reviews (which occur after services are completed). Concurrent review letters and notes demand precise, current clinical language and must avoid recycling language from the initial authorization.
Usage
Usage note: Hyphenate only when used as a compound modifier: 'concurrent-review criteria.' Do not use interchangeably with 'utilization review,' which is the broader process of which concurrent review is one component.
In Context
- "The case manager submitted the concurrent review documentation on day three of the inpatient admission, citing active suicidal ideation and medication adjustment." — Inpatient concurrent review note
- "The editor noted that the concurrent review letter replicated the prior authorization language verbatim, which would likely trigger a payer denial." — Editorial quality review