Resuming Concurrent Review for Inpatient Psychiatric Admissions and Psychiatric Residential Treatment Facility Admissions

01/30/2025

Dear provider and provider staff,

Thank you for your continued partnership in serving WellCare of Kentucky members. We have important information to share with you related to concurrent review for inpatient psychiatric admissions and psychiatric residential treatment facility (PRTF) admissions.

Concurrent review is a collaborative tool to ensure that members already admitted to an inpatient or PRTF level of care are receiving quality, medically necessary, and appropriate care tailored to the individual needs.

Effective May 1, 2025, WellCare will resume concurrent review activities for inpatient psychiatric admissions and psychiatric residential treatment facility admissions. We are confident that restoring this collaborative model for inpatient psychiatric and PRTF stays will contribute directly to better outcomes for our members by facilitating a more formalized structure that supports joint discharge planning activities that support member needs.

This means that upon request, a submittal of the appropriate clinical documentation to WellCare clinicians is applicable related to member stays. This will be a collaborative process in which WellCare clinicians will schedule concurrent review discussions and offer necessary peer-to-peer opportunities.

Again, we thank you for your continued partnership in delivering quality healthcare to our members. If you have any questions regarding this notice, please contact your Provider Relations Representative.

Sincerely,
WellCare of Kentucky