Completion of Outpatient Treatment Review (OTR) Forms

Outpatient Treatment Review (OTR) forms are used by the MCE’s to gain clinical details about a member’s treatment and help determine medical necessity for a member’s care.  These forms provide clinical information regarding a member’s symptoms, diagnoses, level of functioning, risk factors, medications, treatment goals and clinical interventions.   This kind of clinical documentation is a record of the treating provider’s knowledge, observation, judgment and decisions.  Therefore, the treating provider is responsible to make sure the OTR’s are complete, accurate, current and legible.

Treating providers are often very busy seeing members and may often rely on the assistance of administrative staff to help with paperwork demands.  However, the MCE’s are finding that some OTR’s are being completed by non-clinical administrative staff and as a result, significant clinical information is being left out, marked incorrectly, or is not explained in enough detail.  Some examples include: marking the wrong boxes for lethality or risk factors and inaccurate information about current symptoms and prior treatment.  These kinds of errors in documentation are critical and result in additional work for the MCE’s utilization management staff and the treating providers.  The MCE’s request that the treating providers complete the OTR themselves.  If that is not possible and the OTR is completed by non-clinical staff, it is important that the treating provider review and provide oversight of the OTR documentation to make sure all of the member’s information  is accurate and comprehensive.

MDwise and Cenpatico have online resources and tools that provide forms and instructions pertaining to the completion of OTR’s.  These resources outline necessary information that is required on the OTR, such as essential clinical elements of an OTR and a description of SMART goals.  Following are the links to the websites for MDwise: www.mdwise.org and Cenpatico: www.cenpatico.com.

Search under “Providers” to access behavioral health resources and tools.

If you have questions regarding the OTR process or need more information please contact the following individuals:

Lynn Bradford, Ph. D., HSPP
Director of Behavioral Health
MDwise,Inc.
lbradford@mdwise.org
(317) 822-7307

Andrea Fabbiano, LMHC
Outpatient Utilization Manager
Cenpatico
afabbiano@cenpatico.com
(877) 264-6550 x41669