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What is utilization review?

April 26, 2017review utilization

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What is utilization review?

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A. Aetna reviews specific services to evaluate the appropriateness, necessity and quality of health care. This review allows the patient to be more involved in the plan and delivery of treatment. The review uses established criteria and standards that addresses not only the plan of treatment, but also the monitoring of continued treatment. Utilization Review includes: pre-certification of hospital admissions and elective surgery, concurrent hospital review and discharge planning, second surgical opinion when appropriate, high risk pregnancy, and large claim management.