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Standardized Clinical Review

In response to feedback that you would like quick and efficient clinical reviews and standardized interactions, we are enhancing our clinical review process. We listened and we incorporated provider preferences into the development of this new process, so that we are easier to work with clinically and administratively.

The New Clinical Review Process

Clinical reviews for Intensive Outpatient (IOP) and higher levels of care are being simplified in the following ways:

  • Clinical reviews are standardized for a consistent experience, every time
  • Our system captures the right amount of information for each case during the clinical review
  • Streamlined information capturing will make phone conversations with Care Advocates more efficient

Streamlined Information Gathering

  • Our new process includes a greater focus on live reviews in order to complete clinical conversations and care coordination in one call, saving time and avoiding call backs
  • Care Advocates will capture the clinical picture quickly, using checklists instead of narrative reviews

Capturing the Right Clinical Information

  • Our new system prompts for relevant information based on current symptoms and diagnosis to ensure we capture the right clinical information, every time
  • Drill-down questions are asked only when clinically indicated to collect specific details as needed
  • Facility feedback indicates that the information we capture is very similar to the information in your systems
  • Reviews will conclude with a request for verbal attestation from the Facility reviewer verifying that information provided accurately reflects the medical record

Type of Clinical Reviews

  • Clinical reviews for the Intensive Outpatient (IOP) level of care and higher will follow the new clinical review process
  • While the new process will be used by all of our Care Advocacy Centers nationally, there are a few exceptions for specific customers, as noted below:
    • County of San Diego Medi-Cal
    • OptumHealth Pierce RSN
    • OptumHealth Salt Lake County
    • Medica Health Plans
    • UnitedHealthcare Community Plan in Tennessee

Additional Information

The following materials were mailed to Facilities in August, 2012; please feel free to print and share these helpful tools with your Intake and Utilization Review staff