concurrent review
Ongoing utilization review process conducted during a patient's treatment to assess medical necessity and appropriate level of care.
Full Definition
Concurrent review is a utilization management process performed by insurance companies or managed care organizations during active treatment to evaluate the ongoing medical necessity, appropriateness, and efficiency of psychiatric care. Reviewers assess whether the current level of care remains appropriate, if treatment goals are being met, and if continued authorization should be granted. The process typically involves regular communication between treating providers and insurance reviewers, submission of clinical documentation, and may result in continued authorization, step-down recommendations, or denial of further coverage. This real-time review mechanism helps ensure appropriate resource utilization while maintaining quality care standards.
Usage
Usage note: Use 'concurrent review' as two words, not hyphenated.
In Context
- "The concurrent review determined that the patient met criteria for continued inpatient psychiatric treatment." — Insurance authorization documentation
- "Clinical staff must provide updated treatment plans and progress notes for the concurrent review process." — Administrative procedure