utilisation review

utilisation review

Evaluation of the necessity (e.g., for surgery or other therapy), appropriateness (of admissions or of services ordered) and efficiency of the use of healthcare services, procedures, and facilities.

Components
Pre-admission reviews, concurrent (i.e., while patient is in hospital) reviews, reviews of procedures, levels of care and medical necessity after discharge.
References in periodicals archive ?
Nexus, a provider of utilisation review and independent clinical reviews for the risk management and claims management industry, revealed on Monday the appointment of Gordon Breslav as senior vice president of its business development and its subsidiaries.
7 January 2019 - Pennsylvania, US-based Genex Services, a provider of medical cost containment and disability management services, has acquired California, US-based Excel Managed Care and Disability Services, a provider of occupational and non-occupational medical case management, utilisation review and return-to-work services for the workers' compensation and disability markets, the company said.
Excel Managed Care and Disability Services provides occupational and non-occupational medical case management, utilisation review and return-to-work services to employers, insurers, and claims administrators with employees covered by workers' compensation, group health, and long-term disability.
Contract notice: NHS England Clinical Utilisation Review Software.
URAC's Health Utilisation Management Accreditation reportedly ensures that all types of organisations conducting utilisation review follow a process that is clinically sound and respects patients' and providers' rights, address the use of evidence-based guidelines, outline specific reviewer requirements for each level of review and require a policy preventing financial incentives to doctors and other providers based on consumers' use of health services as well as meet the demands of a changing healthcare system.
3 August 2015 - US-based workers' compensation clinical services provider Genex Services has acquired US-based workers' compensation utilisation review software and services provider Comprehensive Industrial Disability Management Services Inc., the company said.
With this acquisition, Genex is positioned to offer an expanded utilisation review program, extending its existing UR capabilities to include CID's best-in-class UR software-as-a-service solution.
Contract award: EMPACT Utilisation Review Software Tools.