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Updates to initial and concurrent reviews in Utilization Management

Updated on December 17, 2021

Organizations need to distinguish between initial and concurrent reviews at the point of admission to an acute or sub-acute level of care (inpatient hospital, inpatient rehabilitation facility, or skilled nursing facility). The Pega Care Management application now differentiates between an initial review and the subsequent or concurrent reviews to accomplish this process.

Organizations can report on initial and concurrent reviews and more easily distinguish the state of review and where it is in the process. Additionally, the case type name that is listed in the case tree is Medical necessity review.

For information about concurrent review and the AdmissionMicrojourney, see Admission.

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