Psychiatric Inpatient Concurrent Review Manual
The California Psychiatric Inpatient Concurrent Review Manual, developed in collaboration with the California Mental Health Services Authority (CalMHSA), serves as a comprehensive guide for managing the concurrent review and authorization processes of psychiatric inpatient hospital services within California’s Medi-Cal Fee-For-Service system. This manual, updated as of January 2025, outlines standardized procedures to ensure that Medi-Cal beneficiaries receive appropriate and timely psychiatric care while maintaining compliance with state and federal regulations.
CalMHSA Psychiatric Inpatient Concurrent Review Manual – January 2025
Key Components of the Manual:
- Introduction to Acentra Health: Provides an overview of Acentra Health’s role in administering concurrent reviews, including contact information, leadership details, and organizational structure.
- Participating Counties: Lists the California counties that have partnered with CalMHSA and Acentra Health for the concurrent review program, facilitating streamlined processes across regions.
- Concurrent Review Process: Details the procedures for initiating and continuing authorization for psychiatric inpatient services, including definitions, medical necessity criteria, and regulatory compliance requirements. It also covers workflows for concurrent reviews, administrative day determinations, adverse benefit determinations, appeals processes, and retrospective authorizations.
- Atrezzo Provider Portal: Introduces the Atrezzo Provider Portal, a secure online platform for providers to submit treatment authorization requests (TARs), access reports, and communicate with Acentra Health reviewers. This section includes guidance on system navigation, security protocols, and utilization review functionalities.
By adhering to the guidelines set forth in this manual, providers can ensure that psychiatric inpatient services are delivered effectively, beneficiaries receive necessary care promptly, and all processes align with Medi-Cal policies and standards.