PBH conducts concurrent review by monitoring services during
treatment to ensure that the member's needs are being met
by the authorized visits and treatment plan.
Concurrent review may include the following:
Review of the written Provider Assessment Report, and/or
Life Status Questionnaire (see documentation
requirements in the Provider Guidelines section of this
manual)
Speaking by phone to the provider and/or a utilization
review nurse at a facility
Review of the medical chart, treatment plan and/or discharge
plan
Speaking with the member's family or significant others
Speaking with the member
The care manager will base treatment authorization decisions
on clinical judgment and written evaluation criteria.
