What is the difference between independent medical review and utilization review?
A utilization review is conducted on behalf of a health plan 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. A medical-necessity review looks at the appropriateness of a specific medical procedure, and may be part of a utilization review. Utilization review is normally conducted by nurses, and independent medical review is always conducted by doctors.
Related Questions
- Is a review of a variance request by the insurance carriers medical professional considered an independent medical examination (IME) or review of records? Also, what how long does the insurance carrier have to respond to the request if the review is performed by its medical professional?
- How does utilization review reach a determination regarding the authorization of medical treatment?
- How are utilization review and medical interpreter fee expenses reported?
