TREATMENT AUTHORIZATION REVIEW SERVICES

2026-11-03

SCOPE OF CONTRACTOR RESPONSIBILITIES A . A Physician Reviewer who will evaluate inpatient records to determine if both acute and administrative days requested meet medical necessity guidelines as outlined by DHCS , with a response time / turnaround time of 48hrs . Physician Reviewer would need to provide in writing , a clear and concise explanation of the decision . It includes a description of the criteria or guidelines used and the clinical reasons for the decision in regard to medical necessity . B . If the hospital appeals the 1st denial or modification of days , a different Physician Reviewer to provide a 2nd level of review of said documentation . Physician Reviewer would need to provide in writing , a clear and concise explanation of the decision . It includes a description of the criteria or guidelines used and the clinical reasons for the decision in regard to medical necessity , C . In the event bed days are officially denied , Physician reviewer to be available same business day , for any “ docto - doc ” conversations regarding medical necessity in documentation that the inpatient facility requests . Doc - to - doc conversation can be held telephonically ...

California

2026-03-27