Utilization Review

Concurrent Review Call Prep

Eight prompts in a practical order for payer-review calls. Add brief chart-based notes and use the output as a one-page call outline.

Use a de-identified case label. Draft autosaves locally in this browser; nothing is sent. Clear when done.

This worksheet follows a practical sequence for organizing a review call — it is not MCG, InterQual, ASAM, or any specific payer's form. Your payer may use a different framework or order; adapt as needed.

Case prep

Brief, specific notes are easier to use on the call. Include times, doses, and observations. Avoid vague phrases that invite follow-up questions.

Draft autosaves locally in this browser. Nothing is sent. Clear when done.

1.Case identifier & current authorization

Open with: de-identified case label, current level of care, admission date, currently authorized through, and how many more days you are requesting.

Use a fake label like Case ABC-FAKE-01. Reviewers want this in the first 20 seconds.

2.What has changed since the last review

What is clinically different from the prior review? New symptoms, medication adjustments, incidents, response to interventions.

If nothing has changed, say so plainly — reviewers will ask anyway and "no change" is a real answer.

3.Active problems supporting continued stay at this level

Why is a lower level of care not yet safe or effective? Concrete clinical reasons, not general language.

Avoid "continues to need treatment" or "still has cravings." Name the specific clinical condition and the gap to step-down.

4.Active treatment in the last 24–72 hours

Specific interventions delivered, frequency, by whom. Group, individual, medication management, family contact, case management.

Reviewers count interventions. Vague "participated in programming" is a denial risk.

5.Treatment plan goals and current progress

Each measurable goal, with one or two concrete examples of progress or lack of progress against it.

Tie each goal to an observable behavior. "Identified 3 triggers in group on 5/22" beats "working on triggers."

6.Risk factors and safety considerations right now

Current withdrawal status in plain language, suicidality, recent use during pass/AMA, acute medical changes.

If your facility uses a withdrawal protocol score, reference the clinical observation rather than the score itself unless the reviewer asks.

7.Barriers to step-down

What specifically would have to change before the patient could safely step down? Be concrete.

Barriers tied to clinical instability or environment land better than barriers tied only to patient preference.

8.Discharge plan and step-down target

Projected step-down level, anticipated discharge date, aftercare arranged, what is still pending.

Reviewers want to hear the plan is concrete, not aspirational.

Requested additional daysProposed next review date

This is a call-prep worksheet for utilization-review staff and case managers — not medical or legal advice, not a payer's form, and not a substitute for your own clinical judgment or your payer's actual UM criteria. Drafts autosave to this browser only; nothing is sent anywhere.