Joshua Rivera

An insurance case manager may review treatment needs, coordinate benefits and authorizations, and communicate with providers during rehab, but does not replace the treatment team.

A medical necessity review evaluates whether a requested addiction treatment service or level of care is clinically appropriate and meets an insurance plan’s coverage criteria.

Concurrent review is an insurance or utilization-management review that occurs while residential rehab is underway to determine whether continued care at that level remains medically necessary.

Utilization review is the process of evaluating whether addiction treatment is medically necessary, appropriate for the current level of care, and consistent with benefit requirements.

ASAM levels are clinical intensity standards, while detox, residential, PHP, and IOP are common treatment labels that may correspond to different parts of the care continuum.

ASAM Criteria are clinical standards used to match a person’s addiction-treatment needs with an appropriate level of care based on a multidimensional assessment.

A biopsychosocial assessment reviews biological, psychological, and social factors that can affect addiction, treatment needs, and recovery planning.

Medication reconciliation at rehab admission is the process of confirming a complete, accurate medication list and comparing it with new treatment orders to reduce medication errors and support safe care.