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Optum PHP continued-stay review

Fictional PHP continued-stay review. The evidence checklist is complete and human review is next.

UNDER REVIEW

Estimated value

$18,400

Deadline

15 days left (fictional sample)

Linked policy

Optum - de-identified demo

Payer route / Optum / United Behavioral Health

Check reconsideration before appeal

Optum commonly offers claim reconsideration followed by appeal, but availability depends on the plan, state, and decision type.

01Verify whether reconsideration is available before using an appeal level for this claim.
02Record every payer representative name and call reference number.
03Match the route to the member's exact plan, product, service date, and state.
04Use the submission method and address printed on the adverse-benefit notice.
05Save the confirmation number, timestamp, and a copy of the complete packet.

Some Optum products and states do not use the same two-step reconsideration and appeal process. The adverse-benefit notice and member plan control when they conflict with this workflow guide. ClaimParrot does not infer a filing deadline; staff must verify the notice or plan document.

Verify with Optum Provider Express

Packet review manifest

Bind a human acknowledgment to the exact source documents, generated letters, and completed evidence items in this packet.

Not reviewed

Source documents: 2
Generated letters: 1
Evidence ready: 3
Evidence gaps: 4

4 evidence items are still open. You may record review, but the gap remains visible in the manifest.

I reviewed the source documents, evidence gaps, and generated language in this packet. I understand ClaimParrot does not make clinical, coding, legal, or payer decisions.

Manifest 0c66565e3a20

Pilot workflow measurement

Record operational evidence for this de-identified case. Do not enter patient, member, or clinical details.

Clinical Evidence Readiness

Prepare the clinical, authorization, and payer records a qualified reviewer needs before an appeal is sent.

3/7 ready

Adverse-benefit determination and every page of the payer noticeAuthorization history, reference numbers, and call notesCurrent treatment plan with measurable goals and progressRelevant clinical notes for the dates under reviewProgress since admission and remaining barriers to safe dischargeUpdated risk assessment and discharge-readiness criteriaStep-down plan and why transition is not yet clinically appropriate

Log a payer or peer-to-peer conversation

Name, title, or extension

What they said

Production billing workspaces encrypt this call log at rest and record access. Keep pilot notes de-identified until your approved PHI environment is active.

Utilization review department

2026-07-14 10:30

Fictional note: requested the missing continued-stay criteria and confirmed the review deadline.