Continued stay reviews

It’s important for CarePartners of Connecticut’s utilization management (UM) team to collaborate with you on care and discharge planning to monitor the patient’s progress, help ensure that they receive the right care based on their health needs, and assist in a smooth transition of care.

To that end, we’re sharing a reminder that our UM team conducts concurrent review for members admitted to an acute inpatient facility for medical and surgical care. This includes initial reviews, as well as ongoing continued stay reviews throughout the hospital admission. InterQual criteria are applied as the basis for these reviews, but these criteria do not replace Medicare or Medicaid coverage guidelines, which are used in making coverage determinations where available.

Providers should be aware that we will be expanding these reviews for diagnosis-related group (DRG) admissions (also known as case rate admissions) in the coming year. As a result, you may notice CarePartners of Connecticut reaching out to your facility more often throughout a patient’s stay for subsequent reviews of clinical information to make coverage determinations and substantiate a continued stay.

For additional information on utilization management and review, please refer to the CarePartners of Connecticut Provider Manual.