utilization review


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Related to utilization review: Drug Utilization Review

utilization review

n.
A process for monitoring the use and delivery of services, especially one used by a managed care provider to control health care costs.

utilization review (UR)

[yo̅o̅′tilīzā′shən]
Etymology: L, utilis + atus, process
an assessment of the appropriateness and economy of an admission to a health care facility or a continued hospitalization. The length of the hospital stay also is compared with the average length of stay for similar diagnoses.

utilization review

Utilization control, utilization management Managed care Evaluation of the necessity–eg, for surgery or other therapy, appropriateness–of admissions or of services ordered, and efficiency of the use of health care services, procedures, and facilities. See Utilization.

utilization review

Evaluation of the necessity, quality, effectiveness, or efficiency of medical services, procedures, and facilities. In regard to a hospital, the review includes appropriateness of admission, services ordered and provided, length of stay, and discharge practices.
References in periodicals archive ?
Although they share many common elements, state utilization review laws
The outcomes of all Medicare and Medicaid utilization reviews were identified for each of the physicians practicing in the three group practices.
California Jury Clears Blues on Utilization Review Call.
It will provide on-line prospective drug utilization review for 100 pharmacies throughout the state.
Utilization review decisions that adversely affect patient care because of a flawed process can be deemed negligent.
TAO is one of the first behavioral managed care companies to be certified by the Utilization Review Accreditation Commission, an industry acknowledged quality care certification.
The company's unique position as the only fully licensed utilization review agent operating in Texas enables it to either contract directly with insurers and employers to carve out chiropractic services for spinal and neck injuries, or subcontract to broad networks to provide managed chiropractic care under umbrella service agreements.
The objective of Department of Community Health (DCH) for this procurement is to obtain the services of a qualified Supplier to provide Medical Management and Utilization Review Services for Medicaid Fee-for-Service (FFS) Members.
Designed specifically for the workers' compensation industry, DataCare's Ahshay supports medical case management, express approval, utilization review, bill review and utilization review connectivity, decision analytics, case/workflow management, correspondence management and system administration.
Utilization review in workers' compensation is one of the many tools we have available to ensure that an injured employee receives the best, most appropriate medical care necessary to achieve a quick and sustainable return to work.
He has played several advisory roles within the National Committee for Quality Assurance and the Utilization Review Accreditation Commission.
It includes cases studies, best practices and strategies for handling patients and physicians, discharge planning, utilization review and related management operations.