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What is a utilization review?

April 26, 2017review utilization

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What is a utilization review?

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The utilization review is a cost-control program used by managed-care plans to reduce any unnecessary medical services. On behalf of an insurer, either an individual or an organization reviews the need, use, appropriateness, efficacy or efficiency of healthcare services, procedures, providers, facilities or quality of service. For example, a hospital review may include a pre-admission certification review concurrently with a discharge, planning and a retrospective review of the case.