Professional review

The Authorized Clinical Reviewer considers the request and submitted plan. The decision records the reviewed source revision, reviewer, date, reason and operation key. It is the point where clinical judgment is attached to a specific scope.

A reviewer may Approve, Reject or Return a submitted plan. Authorization of the request also requires external authorization evidence before its status becomes Authorized. The operation receipt lets the team see whether a guarded change completed or needs review.

• Source. The reviewer opens the submitted plan and current care request, then compares the patient reference, planned sessions and therapist with the supporting material.
• Decision. The decision records a reason, reviewer and source revision on the parent request. A changed revision goes through review again before authorization.
• Follow-up. External authorization evidence is checked before the request becomes Authorized. The receipt records the guarded action separately from the professional decision.

Agree the professional authority for each practice, how independent review is assigned and which evidence must accompany the decision. Keep the preparer and decision maker distinct when configuring access.

Confirm which team member can act for the practice and how staff check the current revision. Rehearse a changed case with the person who receives this handoff.

Present a submitted plan with a later revision than the one in the decision. Confirm that the old decision remains in the record and the changed scope goes back for review. Include a rejected case with a reason and a repeated operation key.

Have the next person open the linked request and explain what changed, who decided, and which evidence supports the current state. Repeat with a stale revision; the team should return to the current record before acting.

Use a decision with a clear reason in the first rehearsal. Ask the coordinator to find that reason from the care request, then have operations find the operation receipt for the authorization. The two records answer different questions: what the professional decided and whether the guarded action completed.

A decision can Approve, Reject or Return. Record the reason on the decision even when a plan is approved, so the coordinator can distinguish professional judgment from a receipt showing whether the guarded change completed. The reviewer should check the current source revision again if the coordinator resubmits a revised plan.

• Review Decision Register — Decisions with their source revisions, reasons and named reviewers.
• Therapy Plans Awaiting Review — Submitted plans needing a current professional decision.

See the process and implementation steps for a rehearsal that includes a changed revision and an unresolved response.