Utilization Review Note

84% popular

Template for insurance utilization review and continued care justification

utilization review insurance continued care

Template Preview

Treatment Summary

Treatment period: [start to current]. Sessions completed: [number]. Frequency: [weekly/bi-weekly/etc]. Modality: [individual/group/family].

Clinical Progress

Symptom improvement: [measurable changes]. Functional gains: [work/school/social]. Risk reduction: [safety improvements]. Goal achievement: [progress toward goals].

Medical Necessity

Current symptoms: [ongoing issues]. Functional impairment: [continued limitations]. Risk factors: [current risks]. Treatment response: [client's response to treatment].

Continued Care Justification

Why continued care: [specific reasons]. Frequency needed: [justification]. Expected duration: [timeline]. Discharge criteria: [when ready to discharge].

Treatment Plan

Focus areas: [specific interventions]. Measurable goals: [objective goals]. Progress indicators: [how to measure]. Timeline: [expected duration].

Risk Assessment

Current risk level: [low/medium/high]. Risk factors: [specific risks]. Protective factors: [strengths]. Safety plan: [if needed].

How to Use This Template

1
Review the template structure
Familiarize yourself with the sections and their purposes before your session.
2
Customize for your practice
Click "Edit & Download" to modify the template to fit your specific needs and clinical approach.
3
Save and reuse
Download as PDF for immediate use, or use within HIPAAtherapy to auto-fill client details and save to your records.